Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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LOW DOSE THERAPEUTIC TREATMENT
RELATED APPLICATIONS
This application claims the benefit of priority and under 35 USC 119(e) of US
provisional applications serial number 62/275,314 filed January 6, 2016, the
contents of
which are incorporated herein by reference.
FIELD AND BACKGROUND OF THE INVENTION
The present invention, in some embodiments thereof, relates to delivery of a
low
dose of THC through inhalation, and, more particularly, but not exclusively,
to methods,
devices and systems for delivering a dose of between 0.2-2 mg THC through
inhalation.
Publication titled "The Pharmacokinetics, Efficacy, Safety, and Ease of Use of
a
Novel Portable Metered-Dose Cannabis Inhaler in Patients With Chronic
Neuropathic
Pain: A Phase la Study" (J Pain Palliat Care Pharmacother. 2014 Sep;28(3):216-
25.
doi: 10.3109/15360288.2014.941130. Epub 2014 Aug 13.) discloses: "Chronic
neuropathic pain is often refractory to standard pharmacological treatments.
Although
growing evidence supports the use of inhaled cannabis for neuropathic pain,
the lack of
standard inhaled dosing plays a major obstacle in cannabis becoming a "main
stream"
pharmacological treatment for neuropathic pain. The objective of this study
was to
explore the pharmacokinetics, safety, tolerability, efficacy, and ease of use
of a novel
portable thermal-metered-dose inhaler (tMDI) for cannabis in a cohort of eight
patients
suffering from chronic neuropathic pain and on a stable analgesic regimen
including
medicinal cannabis. In a single-dose, open-label study, patients inhaled a
single 15.1
0.1 mg dose of cannabis using the Syqe Inhaler device. Blood samples for A(9)-
tetrahydrocannabinol (THC) and 11-hydroxy-A(9)-THC were taken at baseline and
up
to 120 minutes. Pain intensity (0-10 VAS), adverse events, and satisfaction
score were
monitored following the inhalation. A uniform pharmacokinetic profile was
exhibited
across all participants (A(9)-THC plasma Cmax SD was 38 10 ng/mL, Tmax
SD
was 3 1 minutes, AUC0¨>infinity SD was 607 200 ng-min/mL). Higher plasma
Cmax increase per mg A(9)-THC administered (12.3 ng/mL/mg THC) and lower
interindividual variability of Cmax (25.3%), compared with reported
alternative modes
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of THC delivery, were measured. A significant 45% reduction in pain intensity
was
noted 20 minutes post inhalation (P = .001), turning back to baseline within
90 minutes.
Tolerable, lightheadedness, lasting 15-30 minutes and requiring no
intervention,
was the only reported adverse event. This trial suggests the potential use of
the Syqe
Inhaler device as a smokeless delivery system of medicinal cannabis, producing
a
THC pharmacokinetic profile with low interindividual variation of Cmax,
achieving
pharmaceutical standards for inhaled drugs."(Abstract)
Publication titled "Efficacy of Inhaled Cannabis on Painful Diabetic
Neuropathy" (J Pain. 2015 Jul;16(7):616-27. doi: 10.1016/j.jpain.2015.03.008.
Epub
2015 Apr 3.) discloses "A randomized, double-blinded, placebo controlled
crossover
study was conducted in 16 patients with painful diabetic peripheral neuropathy
to assess
the short-term efficacy and tolerability of inhaled cannabis. In a crossover
design, each
participant was exposed to 4 single dosing sessions of placebo or to low (1%
tetrahydrocannabinol [THC]), medium (4% THC), or high (7% THC) doses of
cannabis.
Baseline spontaneous pain, evoked pain, and cognitive testing were performed.
Subjects
were then administered aerosolized cannabis or placebo and the pain intensity
and
subjective "highness" score was measured at 5, 15, 30, 45, and 60 minutes and
then
every 30 minutes for an additional 3 hours. Cognitive testing was performed at
5 and 30
minutes and then every 30 minutes for an additional 3 hours. The primary
analysis
compared differences in spontaneous pain over time between doses using linear
mixed
effects models. There was a significant difference in spontaneous pain scores
between
doses (P < .001). Specific significant comparisons were placebo versus low,
medium,
and high doses (P = .031, .04, and <.001, respectively) and high versus low
and medium
doses (both P < .001). There was a significant effect of the high dose on foam
brush and
von Frey evoked pain (both P < .001). There was a significant negative effect
(impaired
performance) of the high dose on 2 of the 3 neuropsychological tests (Paced
Auditory
Serial Addition Test, Trail Making Test Part B."(Abstract)
Publication titled "Low-dose vaporized cannabis significantly improves
neuropathic pain." (J Pain. 2013 Feb;14(2):136-48. doi:
10.1016/j.jpain.2012.10.009.
.. Epub 2012 Dec 11.) discloses "We conducted a double-blind, placebo-
controlled,
crossover study evaluating the analgesic efficacy of vaporized cannabis in
subjects, the
majority of whom were experiencing neuropathic pain despite traditional
treatment.
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Thirty-nine patients with central and peripheral neuropathic pain underwent a
standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or
placebo cannabis with the primary outcome being visual analog scale pain
intensity.
Psychoactive side effects and neuropsychological performance were also
evaluated.
Mixed-effects regression models demonstrated an analgesic response to
vaporized
cannabis. There was no significant difference between the 2 active dose
groups' results
(P> .7). The number needed to treat (NNT) to achieve 30% pain reduction was
3.2 for
placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium-
versus low-dose. As these NNTs are comparable to those of traditional
neuropathic pain
medications, cannabis has analgesic efficacy with the low dose being as
effective a pain
reliever as the medium dose. Psychoactive effects were minimal and well
tolerated, and
neuropsychological effects were of limited duration and readily reversible
within 1 to 2
hours. Vaporized cannabis, even at low doses, may present an effective option
for
patients with treatment-resistant neuropathic pain." (Abstract)
Publication titled "Smoked cannabis for chronic neuropathic pain: a randomized
controlled trial." (CMAJ. 2010 Oct 5;182(14):E694-701. doi:
10.1503/cmaj.091414.
Epub 2010 Aug 30.) discloses: "BACKGROUND: Chronic neuropathic pain affects
1%-2% of the adult population and is often refractory to standard
pharmacologic
treatment. Patients with chronic pain have reported using smoked cannabis to
relieve
pain, improve sleep and improve mood. METHODS: Adults with post-traumatic or
postsurgical neuropathic pain were randomly assigned to receive cannabis at
four
potencies (0%, 2.5%, 6% and 9.4% tetrahydrocannabinol) over four 14-day
periods in a
crossover trial. Participants inhaled a single 25-mg dose through a pipe three
times daily
for the first five days in each cycle, followed by a nine-day washout period.
Daily
average pain intensity was measured using an 11-point numeric rating scale. We
recorded effects on mood, sleep and quality of life, as well as adverse
events.
RESULTS: We recruited 23 participants (mean age 45.4 [standard deviation 12.3]
years, 12 women [52%]), of whom 21 completed the trial. The average daily pain
intensity, measured on the 11-point numeric rating scale, was lower on the
prespecified
primary contrast of 9.4% v. 0% tetrahydrocannabinol (5.4 v. 6.1, respectively;
difference = 0.7, 95% confidence interval [CI] 0.02-1.4). Preparations with
intermediate
potency yielded intermediate but nonsignificant degrees of relief.
Participants receiving
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9.4% tetrahydrocannabinol reported improved ability to fall asleep (easier, p
= 0.001;
faster, p < 0.001; more drowsy, p = 0.003) and improved quality of sleep (less
wakefulness, p = 0.01) relative to 0% tetrahydrocannabinol. We found no
differences in
mood or quality of life. The most common drug-related adverse events during
the period
when participants received 9.4% tetrahydrocannabinol were headache, dry eyes,
burning
sensation in areas of neuropathic pain, dizziness, numbness and cough.
CONCLUSION:
A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis
three times
daily for five days reduced the intensity of pain, improved sleep and was well
tolerated.
Further long-term safety and efficacy studies are indicated. (International
Standard
Randomised Controlled Trial Register no. ISRCTN68314063)." (Abstract)
SUMMARY OF THE INVENTION
According to an aspect of some embodiments of the invention, there is provided
a system for delivering to a subject at least one pre-determined amount of
THC, the
system comprising: a memory which stores a scheduled regimen for delivery of
THC to
the subject, the scheduled regimen defining: (a) a maximal amount of THC to be
delivered, the amount being 0.75 mg or less, and (b) a time period within
which the
amount is delivered, the time period being 2 hours or longer; a decision
module which
decides, according to the scheduled regimen, if a delivery should take place;
and an
inhaler device for delivering the THC to the subject, the inhaler device
comprising a
controller which carries out delivery of the THC based on the decision made by
the
decision module. In some embodiments, the system is configured to deliver a
total of no
more than 10 mg THC over a 24 hour time period. In some embodiments, one or
both
of the memory and the decision module are included within the inhaler device.
In some
embodiments, one or both of the memory and the decision module are included
within
the controller. In some embodiments, one or both of the memory and the
decision
module are associated with or included in a smartphone. In some embodiments,
the
inhaler comprises a heating mechanism for heating a quantity of THC-comprising
material to deliver THC from the quantity of THC-comprising material to the
user. In
some embodiments, the controller carries out delivery by controlling one or
more of:
heating parameters, an amount of THC-comprising material being heated, and
regulation of airflow. In some embodiments, the controller carries out
delivery of less
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than the maximal amount by controlling heating of a quantity of THC-comprising
material having a THC content of between twofold and fivefold the amount of
THC
being extracted. In some embodiments, the inhaler includes the quantity of THC-
comprising material. In some embodiments, the controller carries out delivery
of less
5 than the maximal amount by controlling heating of a quantity of THC-
comprising
material having a THC content of between 2 times to 35 times the amount of THC
being
extracted. In some embodiments, the inhaler includes the quantity of THC-
comprising
material. In some embodiments, the inhaler is configured to heat the quantity
of THC-
comprising material only once. In some embodiments, the inhaler is configured
to heat
the quantity of THC-comprising material more than once. In some embodiments,
the
system comprises a cartridge containing the quantity of THC-comprising
material, the
cartridge received within the inhaler. In some embodiments, the cartridge
further
comprises one or more active substances other than THC. In some embodiments,
the
THC-comprising material comprises one or more additional active substances. In
some
embodiments, the decision module is configured to prevent delivery for a time
period
long enough for at least one effect induced by the THC on the subject to take
place. In
some embodiments, the decision module is configured to limit the maximal
amount of
THC to an amount small enough so as not to induce a significant psychoactive
effect on
the subject. In some embodiments, the decision module is configured to allow a
time
window set from initial delivery of an amount smaller than 0.5 mg THC, wherein
during
the time period additional delivery of up to a total of 0.5 mg THC including
the initial
delivery is enabled. In some embodiments, the decision module is configured to
receive
input regarding a THC-comprising material from which the THC is delivered,
and,
according to the input, to adjust the time period. In some embodiments, the
decision
module is configured to adjust the time period according to one or more of: an
amount
or concentration of THC in the THC-comprising material; a strain of the THC-
comprising material and additional active substances included in the THC-
comprising
material. In some embodiments, the system comprises at least two quantities of
THC-
comprising material differing from each other in at least one property
selected from a
group consisting of: a concentration of THC in the quantity, a strain of the
THC-
comprising material, additional active substances included in the THC-
comprising
material, the mass of the quantity of THC-comprising material and the total
amount of
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THC in the quantity of THC-comprising material, and wherein the decision
module is
configured to select which cartridge to use according to a time period defined
for each
of the cartridges according to the at least one property. In some embodiments,
in
predefined exceptions the decision module is configured to allow delivery
exceeding at
least one of the (a) and (b). In some embodiments, delivery under the
predefined
exceptions is limited according to one or more of: no more than two
exceptional
deliveries allowed within a 24 hour period; no more than two exceptional
deliveries
allowed within a 12 hour period; any exceptional delivery allowing no more
than two
folds the maximal amount of THC; and the total amount of THC delivered over a
24
hour period amounts to no more than 10 mg. In some embodiments, following an
exceptional delivery the decision module returns to operate according to the
scheduled
regimen for a time period of at least 2 hours. In some embodiments, the
decision
module is configured to analyze previous amounts delivered within any defined
time
period to determine whether an additional amount can be provided at a current
or future
time point.
According to an aspect of some embodiments of the invention, there is provided
a method of controlling a THC dispensing device, comprising: dispensing an
initial
dose of THC; within a first time window, allowing dispensing of a further dose
of THC
such that a total amount of the initial dose and the further dose is no more
than 0.5 mg
THC; and within a second time window, preventing dispensing of any additional
dose
of THC until the second time window has ended. In some embodiments, the
initial
dose and the further dose of THC are each dispensed over a single delivery
event. In
some embodiments, each of the delivery events takes place during a single
inhalation of
a user of the THC dispensing device. In some embodiments, a total number of
delivery
events over a 24 hour time period is 12 or less. In some embodiments, a total
of no
more than 10 mg THC are dispensed over a 24 hour time period. In some
embodiments,
at least one of the initial dose of THC, the further dose of THC and the
additional dose
of THC is dispensed concomitantly or sequentially with one or more other
active
substances. In some embodiments, no more than 0.75 mg THC are delivered at any
given dose. In some embodiments, a total of the initial dose and the further
dose is
selected to be sufficient to reduce a treated symptom without return of the
symptom to a
pre-inhalation degree for at least as long as the second time window. In some
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embodiments, the second time window is 2 hours or longer. In some embodiments,
the
first time window is selected to be long enough to allow a user to sense the
effect of the
dose of THC. In some embodiments, the first time window is between 15 minutes
to 2
hours from dispensing of the initial dose. In some embodiments, the initial
dose and the
further dose together are lower than a maximal dose allowed within the first
time
window. In some embodiments, the method comprises dispensing an additional
dose of
THC after the second time window has ended. In some embodiments, dispensing
comprises extracting the THC from THC-comprising material.
According to an aspect of some embodiments of the invention, there is provided
a method of pulmonary delivery of a combination of at least two cannabinoids
to a
subject, comprising: delivering a first dose comprising at least two
cannabinoids at a
predetermined ratio; waiting at least two hours; delivering a second dose
comprising a
combination of the at least two cannabinoids at a second ratio different than
the ratio of
the first dose. In some embodiments, the first and second doses comprise THC.
In some
embodiments, the first and second doses comprise CBD. In some embodiments, the
ratio comprises a THC to CBD ratio. In some embodiments, the first and second
doses
comprise CBN. In some embodiments, the ratio includes a THC to CBD ratio. In
some
embodiments, the ratio includes a cannabinoid that is undetectable in at least
one of the
first and second doses. In some embodiments, the second dose is extracted from
a
cannabis strain different from a cannabis strain from which the first dose was
extracted.
According to an aspect of some embodiments of the invention, there is provided
a method of pulmonary delivery of THC to a patient undergoing chemotherapy,
comprising delivering a first dose of 1 mg THC or less at least 30 minutes
before
chemotherapy begins; delivering no more than 10 doses of no more than 1 mg THC
each over a 24 hour period, the doses delivered at time intervals of at least
two hours.
According to an aspect of some embodiments of the invention, there is provided
a method for delivering at least one active substance to a subject through
inhalation,
comprising delivering a first dose of the active substance to the subject;
waiting at least
a time period sufficient for an effect of the at least one active substance to
take place,
and during the time period allowing delivery of a placebo; after the time
period has
ended, allowing delivery of a second dose of the active substance.
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According to an aspect of some embodiments of the invention there is provided
an inhaler for delivering to a subject at least one pre-determined vaporized
amount of
THC, the inhaler comprising a controller configured to limit the amount of THC
to no
more than 2 mg THC delivered in a 2 hour time period. In some embodiments, the
inhaler is configured to deliver a total of no more than 7.5 mg THC over a 24
hour time
period. In some embodiments, the inhaler comprises a heating mechanism for
heating a
THC-comprising material to deliver no more than 2 mg THC from the THC-
comprising
material. In some embodiments, the controller is configured to limit the
amount of THC
by controlling one or more of: heating parameters, an amount of THC-comprising
material being heated, and regulation of airflow. In some embodiments, the
controller is
configured to adjust extraction efficiency. In some embodiments, the inhaler
comprises
a cartridge including a THC-comprising material having a THC content of
between
twofold and fivefold the amount of THC being extracted. In some embodiments,
the
THC-comprising material comprises no more than 3.5 mg THC. In some
embodiments,
the inhaler is configured to heat the cartridge more than once. In some
embodiments, the
cartridge comprises one or more additional active substances. In some
embodiments, the
inhaler comprises a total of 8 cartridges, sufficient for use over a 24 hour
period. In
some embodiments, the controller is configured to prevent delivery for a time
period of
at least 1.5 hours after 30 minutes lapsed from the last delivery event.
According to an aspect of some embodiments of the invention there is provided
a method of pulmonary delivery of THC to a subject, comprising: delivering THC
to the
subject such that within any time period of two hours or more, a total of no
more than
0.2- 2 mg THC are delivered. In some embodiments, the amount of THC is
delivered
over a single delivery event including one or more inhalations of the subject.
In some
embodiments, the method further comprises, prior to the delivering, heating
plant
material to extract the THC. In some embodiments, the method further
comprises, prior
to the delivering, extracting the THC from a material carrying one or more of
extracted,
purified and/or synthetic THC. In some embodiments, the material comprises THC
at an
amount which is between twofold and fivefold the amount of THC being
extracted. In
some embodiments, a total number of delivery events over a 24 hour time period
is 8 or
less, wherein in each delivery event between 0.2-2 mg THC are delivered to the
patient.
In some embodiments, a total of no more than 7.5 mg THC are delivered over a
24 hour
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time period. In some embodiments, THC is delivered concomitantly or
sequentially
with one or more other active substances. In some embodiments, an actual
amount of
THC from the range of 0.2-2 mg THC is selected to be sufficient to reduce a
treated
symptom without return of the symptom to a pre-inhalation degree for a time
period of
two hours or more.
According to an aspect of some embodiments of the invention there is provided
an inhaler for delivering to a subject at least one pre-determined vaporized
amount of
THC from a THC-comprising material by controllably heating the material so as
to
deliver the at least one pre-determined vaporized amount of THC; the device
comprising at least one cartridge in which the THC-comprising material is
contained,
the cartridge sufficient for a single delivery event over which the pre-
determined
vaporized amount of THC is delivered to the subject through inhalation; and
the
cartridge comprising, when fully loaded, THC-comprising material having no
more
than about 3.5 mg of THC.
According to an aspect of some embodiments of the invention there is provided
an inhaler for delivering to a subject at least one pre-determined vaporized
amount of
THC from a THC-comprising material by controllably heating the material so as
to
deliver the at least one pre-determined vaporized amount of THC; the device
comprising at least one cartridge in which the THC comprising material is
contained,
the cartridge sufficient for a single delivery event over which the pre-
determined
vaporized amount of THC is delivered to the subject through inhalation; and
the
cartridge comprising, when fully loaded, no more than 20 mg of THC-comprising
material. In some embodiments, the THC-comprising material is plant material.
In some
embodiments, the plant material is augmented with an extract and/or a
synthetic drug.
According to an aspect of some embodiments of the invention there is provided
an inhaler for delivering to a subject at least one pre-determined vaporized
amount of
THC, the inhaler comprising a controller configured to limit the amount of THC
to no
more than 2 mg THC delivered during any time period sufficient for one or more
effects
of the THC to become significant.
According to an aspect of some embodiments of the invention there is provided
a magazine comprising a plurality of cartridges, each cartridge comprising a
THC-
comprising material at amount which comprises no more than 4 mg THC. In some
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embodiments, an amount of THC is equal for all of the plurality of cartridges.
In some
embodiments, the plurality of cartridges comprise different amounts of THC.
According to an aspect of some embodiments of the invention there is provided
a method of pulmonary delivery of a combination of a low dose of THC and at
least one
5 other cannabinoid to a subject, comprising: delivering a first dose
comprising a
combination of THC and the at least one other cannabinoid at a predetermined
ratio;
waiting at least two hours; delivering a second dose comprising a combination
of THC
and the at least one other cannabinoid at a ratio which is at least 10% larger
or at least
10% smaller than the ratio of the first dose. In some embodiments, the at
least one other
10 cannabinoid is CBD. In some embodiments, the second dose is extracted from
a
cannabis strain different from a cannabis strain from which the first dose was
extracted.
According to an aspect of some embodiments of the invention there is provided
a method of pulmonary delivery of THC to a patient undergoing chemotherapy,
comprising delivering a first dose of 0.5 mg THC at least 30 minutes before
chemotherapy begins; delivering no more than 7 doses of 0.5 mg THC each over a
24
hour period, the doses delivered at time intervals of at least two hours.
According to an aspect of some embodiments of the invention there is provided
a method for delivering a plurality of low doses of at least one active
substance through
inhalation, comprising delivering, within a first time interval, a first low
dose of the
active substance, the first low dose lower than a maximal dose allowed within
the first
time interval; waiting at least a time period sufficient for an effect of the
at least one
active substance to take place; delivering, within the first time interval, a
second dose of
the active substance, the second low dose lower than a maximal dose allowed
within the
first time interval; delivering a third dose of the active substance after at
least two hours
have passed from the delivering of the first dose.
According to an aspect of some embodiments of the invention there is provided
an inhaler configured for delivering a plurality of low doses of at least one
active
substance through inhalation, comprising a controller programmed to limit
delivery of
the active substance according to one or more of: a maximal dose allowed
within a
predetermined time interval, a time period that passed from the last delivery;
an effect
of the active substance as indicated by a user.
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Unless otherwise defined, all technical and/or scientific terms used herein
have
the same meaning as commonly understood by one of ordinary skill in the art to
which
the disclosure pertains. Although methods and materials similar or equivalent
to those
described herein can be used in the practice or testing of embodiments of the
disclosure,
some methods and/or materials are described below. In case of conflict, the
patent
specification, including definitions, will control. In addition, the
materials, methods,
and examples are illustrative only and are not intended to be necessarily
limiting.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
Some embodiments of the invention are herein described, by way of example
only, with reference to the accompanying drawings. With specific reference now
to the
drawings in detail, it is stressed that the particulars shown are by way of
example and
for purposes of illustrative discussion of embodiments of the invention. In
this regard,
the description taken with the drawings makes apparent to those skilled in the
art how
embodiments of the invention may be practiced.
In the drawings:
FIG. 1 is a schematic diagram of a system comprising an inhaler device, a
physician interface and/or a patient interface, according to some embodiments
of the
present disclosure;
FIG. 2 is a flowchart of a method for prescribing a personalized regimen to a
patient, according to some embodiments of the present disclosure;
FIG. 3 is a flowchart of a method for obtaining a personal pharmacodynamic
(PD) parameter from a patient and modifying a regimen accordingly, according
to some
embodiments of the present disclosure;
FIG. 4 is a schematic diagram of a metered dose inhaler device configured to
provide automated controlled pulmonary delivery of one or more active agents,
according to some embodiments of the present disclosure;
FIG. 5 is a schematic diagram of a configuration of an inhaler device (FIG.
17A),
according to some embodiments of the present disclosure;
FIG. 6 is a flowchart of a method of treating an individual patient using a
system
according to Figure 1, while maintaining the patient within a personalized
therapeutic
window, according to some embodiments of the present disclosure;
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FIG. 7 presents a flowchart of a procedure for determining and administering a
personal dosing and/or regimen for treating neurological pain in a human
subject;
FIG. 8 is a flowchart of a method for treating a patient with a low dose of
THC,
according to some embodiments of the invention;
FIG. 9 schematically illustrates an inhaler device configured to deliver one
or
more doses comprising no more than 2 mg THC each, according to some
embodiments
of the invention;
FIG. 10 is a graphical representation of a regimen for the treatment of pain
by
pulmonary delivery of 0.5 mg THC doses provided in time intervals of at least
two
hours, according to some embodiments of the invention;
FIG. 11 is a graphical representation of a treatment effect achieved by
pulmonary delivery of 0.5 mg THC doses, provided at time intervals of at least
two
hours, according to some embodiments of the invention;
FIG. 12 is a flowchart of a method for treating a patient with a combination
of
THC and at least one other cannabinoid at a predetermined ratio, according to
some
embodiments of the invention;
FIG. 13 is a flowchart of a method for delivering one or more low doses of
THC,
according to some embodiments of the invention;
FIG, 14 is a schematic diagram of factors associated with setting of a lock-
out
time period of an inhaler device, according to some embodiments of the
invention;
FIG. 15 is a flowchart of a delivery scheme of at least one active substance
via
an inhaler device, according to some embodiments of the invention; and
FIG. 16 is a graph of a delivery scheme of at least one active substance via
an
inhaler device, according to some embodiments of the invention.
DETAILED DESCRIPTION OF THE INVENTION
The present invention, in some embodiments thereof, relates to pharmacology
and, more particularly, but not exclusively, to methods, devices and systems
for
controlled pulmonary delivery of active agents.
Before explaining at least one embodiment of the invention in detail, it is to
be
understood that the invention is not necessarily limited in its application to
the details
set forth in the following description or exemplified by the Examples.
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As used herein, the terms "pharmacokinetic/pharmacodynamic" and "PK/PD"
mean pharmacokinetic and/or pharmacodynamic. PCT publication W02016/001923,
which is incorporated herein by reference, includes for example the
terms
pharmacokinetic profile, level, effect and/or parameter and pharmacodynamic
profile,
level, effect and/or parameter which are contemplated in this application as
well.
As used herein, the terms "therapeutic window" and "pharmaceutical window"
are interchangeable and refer to the range of pharmacodynamic effects induced
by a
range of doses of one or more pharmaceutically active agents, providing a
balance
between one or more desired (positive) effect(s) and one or more adverse
(negative)
effect(s). According to some embodiments, the pharmaceutical/therapeutic
window is
referred to as a pharmacodynamic profile. The window may relate to a given
point in
time or may span a period of time of any length, including for example
minutes, hours,
days or longer, shorter or to any intermediate period of time. The
desirability and
undesirability of an effect can be defined based on a variety of criteria, and
include
without limitation, medical practices, rules and regulations, cultural and
demographic
norms, genetic factors and personal preferences and tolerances. For example,
the
desirability and undesirability of an effect can be defined based on the
purpose of
treatment and based on generally acceptable values and optionally may take
into
account other parameters such as patient preference, capacity and activity. It
is noted
that a given effect may be regarded as desired in some cases, but be regarded
as
undesired in other cases, and vice versa.
According to some embodiments of the present invention, the methods, devices
and systems provided herein are capable of vaporizing a pre-determined
vaporized
amount of an active agent that induced one or more pre-determined
pharmacodynamic
effects in a given subject or a population of subjects, wherein the pre-
determined
pharmacodynamic effect pertains to a pre-determined pharmacodynamic profile
that
may range between a minimal level of a desired effect and any level of an
undesired
effect.
In some embodiments this a pharmaceutical window spans pharmacodynamic
effects ranging from the lowest level of an effective treatment of a medical
condition
(therapeutic effect; e.g., pain relief) to a highest level of tolerable
adverse effects (e.g.,
tolerable psychotropic effect as described herein). Optionally, the
therapeutic window
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may be correlated to a selected balance between therapeutic and adverse
effects. For
example, the undesired effects are sufficiently tolerable or even minimized,
while the
desired effects reach at least a minimal acceptable level or a minimal
mandatory level
(e.g. life preserving or preserving the function of an organ or system of the
user).
Optionally, an adverse effect may be limited according to a probability of
serious or
irreparable damage to the subject's like or wellbeing. However, several
alternative
balances may be obtainable and one may choose between the optional therapeutic
windows them based on user preferences.
Herein throughout, the term "patient" is used interchangeably with the terms
"subject", "user" and "a person in need thereof' to refer to the entity that
uses any of the
devices and systems provided herein and being the subject of any of the
methods
provided herein.
A therapeutic window can be correlated, via a pharmacokinetic profile, to a
range of amounts of one or more pharmaceutically active agents. For example, a
therapeutic window may be defined as a range of amounts of one or more
pharmaceutically active agent spanning from an amount that confers a desired
effect (a
therapeutic effect, in which case the amount is a therapeutically effective
amount or
therapeutic dose) and an amount that causes more than an acceptable or
tolerable level
of undesired effects (e.g., adverse effects). Hence, for example, a
pharmaceutically
active agent having a narrow therapeutic window should be administered with
great care
and control so as to stay between the therapeutically effective amount and the
amount
that causes an adverse effect.
According to an aspect of some embodiments of the present disclosure, there is
provided a method of pulmonary delivering at least one pharmacologically
active agent
to a patient, which is carried out by pulmonary delivering the agent to the
patient using
a metered dose inhaler device, wherein the device is configured to release at
least one
pre-determined vaporized amount of the agent upon controllably heating a
substance
that contains the agent, wherein the amount is set so as to achieve at least
one pre-
determined effect in a subject, such as a pre-determined pharmacodynamic
effect.
It is to be understood that the pharmaceutically active agent can be in a
solid or a
liquid form, and further noted that the agent is contained in a solid form of
a substance
described herein. According to some embodiments of the present disclosure, the
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pharmaceutically active agent is vaporizable by heat, thereby can be released
from the
substance by being heat-induced vaporization.
According to some embodiments, the substance that contains at least one
vaporizable active agent is, for example, a plant material. In some
embodiments, the
5 active agent is a naturally occurring agent, namely the agent occurs
(produced) naturally
in the plant. Alternatively, the substance is an organic material which
contains, or
consists of, for example, one or more natural plant materials, or a synthetic
material
which may comprise at least one vaporizable active agent. In some embodiments,
the
solid form of a substance comprises a plurality of vaporizable active agents
derived or
10 extracted from natural or organic sources, such as plants, fungi,
bacteria and the likes.
In some embodiments, the substance is a natural plant matter. In an embodiment
of the present disclosure, the plant matter is processed without damaging the
vaporizable active agent in the plant matter. Optionally, the plant matter
retains a
macroscopic plant structure.
15 The
amount of the substance used in the MDI device may be determined based
on the contents of the vaporizable agent contained therein, and on the pre-
determined
vaporized amount required to be released therefrom. The amount of the
substance used
in the MDI device may range from 20 to 500 mg, 10 to 200 mg, 9 to 150 mg, 8 to
100
mg, 7 to 50 mg, 5 to 20 mg, 1 to 10 mg, 10 to 70 mg, 10 to 60 mg, 12 to 50 mg,
12 to 40
mg, 15 to 40 mg, 12 to 30 mg or 12 to 25 mg.
The terms "pharmaceutically active agent", "biologically active agent",
"active
agent" and "agent" are used herein interchangeably and refer to a compound, a
polymer,
a conjugate or a complex, or any combination thereof, which exerts a
physiological or
psychological effect when administered to a subject. Typically, the
pharmaceutically
active agent or biologically active substance exerts a desired physiological
or
psychological effect upon pulmonary delivering thereof via a systemic pathway
(e.g.,
blood, lymph) to a target organ. The agent may be of natural origin or
synthetic. Non-
limiting examples of active agents include CNS active agents, chemotherapeutic
agents,
sedative or analgesic agents and a psychotropic agent. In the context of
embodiments of
the present disclosure, the pharmaceutically active agent is a naturally
occurring agent
found in a naturally occurring substance (e.g., a natural plant substance, as
described
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herein), or a metabolite thereof. These terms also encompass, unless otherwise
indicated, two or more agents.
According to some embodiments of the present disclosure, the method is carried
out using an MDI which is capable of delivering reproducibly and accurately an
amount
of at least one vaporizable agent by heating a solid form of a substance. Such
requirements of an MDI are met by, for a non-limiting example, an MDI as
disclosed in
U.S. Patent Application No. 13/997,302 or WO 2012/085919, both of which is
incorporated herein by reference in its entirety as if fully set forth herein.
According to some embodiments of the present disclosure, the MDI device is a
device as described in WO 2012/085919, including any one of the embodiments
described therein, and any combination thereof.
The term "vaporized amount", as used herein, refers to the amount of an agent
that is in vapor form, whereas the vapor form/amount is obtained by means of a
heating
elements in the MDI device. It is noted herein that in some embodiments the
amount of
vaporized agent in the context of the present disclosure is not an estimated
amount but
rather represents the actual amount vaporized upon said heating.
The term "pre-determined vaporized amount" refers to an amount that is
purposely or knowingly released from the MDI device, the magnitude of which is
determined by choice or by design of a dose and/or regimen protocol, as
described
herein. In the context of some embodiments, the term "dose" represents a pre-
determined vaporized amount. It is noted that a pre-determined vaporized
amount is
correlated to an available amount present in the device, and that one can pre-
measure
the available amount present in the device, or measure the available amount
present in
the device in conjunction to the administration event, and thereby preset,
reset, adjust
and/or readjust the pre-determined vaporized amount accordingly.
Initial dose determination and device calibration:
According to some embodiments, the method is performed such that the pre-
determined vaporized amount is selected/controlled so as to exhibit a pre-
selected (also
referred to herein as pre-determined) pharmacokinetic profile and/or a pre-
selected or
pre-determined pharmacodynamic profile of the agent in the patient.
In some embodiments, the pre-determined vaporized amount is
selected/determined arbitrarily, while the MDI device is configured to
vaporize and
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deliver this amount consistently and accurately throughout any number of uses
and
inhalations, using any source of the active agent (substance; plant material,
combination
of plant material with another material etc.). According to some embodiments,
a pre-
determined vaporized amount of an agent can be determined based on a
measurement of
.. the amount of the agent per unit mass of the substance from which the agent
is to be
vaporized. Such measurement can be carried out by standard procedures; thereby
various batches and sources of the substance can be standardized according to
the
relative amount of the agent per unit mass of the substance.
It is noted herein that according to some embodiments of the present
disclosure,
by exhibiting a pre-selected pharmacokinetic and/or pharmacodynamic profile,
it is
meant that the vaporized amount of the agent has been pre-determined based on
pharmacokinetic/pharmacodynamic (PK/PD) studies conducted in at least one
subject
by pulmonary delivering the agent using an MDI device which is configured to
release a
consistent and accurate vaporized amount of the agent upon heating a solid
substance
comprising the same. It is also noted herein that according to some
embodiments of the
present disclosure, by exhibiting a pre-selected pharmacokinetic profile, it
is meant that
at least one desired pharmacokinetic profile has been identified and that at
least one pre-
determined vaporized amount of the agent has been shown to effect that desired
pharmacokinetic profile in a subject. It is also noted herein that according
to some
embodiments of the present disclosure, by exhibiting a pre-selected
pharmacodynamic
profile, it is meant that at least one desired pharmacodynamic profile has
been identified
and that at least one pre-determined vaporized amount of the agent has been
shown to
effect that desired pharmacodynamic profile in a subject.
In some embodiments of the present disclosure, the terms "pre-selected" and
.. "pre-determined" refers to, or used interchangeably with, the terms
"intended",
"desired" or "desirable", or with the terms "effective", "needed" and
"therapeutic".
In some embodiments, the term "pre-determined vaporized amount" is also used
herein to describe the amount of the agent that is determined based on
pharmacokinetic/pharmacodynamic (PK/PD) data, namely a vaporized amount that
has
been determined by determining PK/PD effects (parameters) for the agent in one
or
more patients.
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In some embodiments, configuring the MDI device to release a pre-determined
amount as defined herein means, in some embodiments, calibrating the device to
exhibit
a pre-selected PK and/or a pre-selected PD profile.
According to some of any of the embodiments of the present disclosure, the
method is carried out by adjusting the pre-determined vaporized amount so as
to
achieve a pre-determined pharmacokinetic effect and/or a pre-determined
pharmacodynamic effect based on data indicative of at least one
pharmacokinetic effect
and/or at least one pharmacodynamic effect induced by the agent in the
subject.
In some embodiments, the method further includes generating the indicative
data
by monitoring at least one pharmacokinetic effect and/or at least one
pharmacodynamic
effect induced by the agent in the subject.
According to some of any of the embodiments of the present disclosure, the
method is carried out by monitoring and/or determining at least one
pharmacokinetic
effect and/or at least one pharmacokinetic variable and/or at least one
pharmacodynamic
effect, as these terms are defined herein, which are induced by pulmonary
delivering the
pharmaceutically active agent to a patient using the MDI device;
based on the pharmacokinetic effect and/or the pharmacokinetic variable and/or
the pharmacodynamic effect, determining the pre-determined vaporized amount
which
exhibits the pre-selected pharmacokinetic profile and/or the pre-selected
.. pharmacodynamic profile of the agent in the patient; and
adjusting the MDI device to deliver the pre-determined vaporized amount of the
agent.
As used herein, the phrase "pharmacokinetic profile" refers to a bodily
concentration of a pharmaceutically active agent, or a metabolite thereof
(e.g., an active
metabolite), namely, a concentration of the agent or a metabolite thereof in a
physiological system of an organism (whole body, blood, plasma, lymph, tissue,
organ
and the likes) to which the compound has been administered, as a function of
time.
Typically, a pharmacokinetic (PK) profile is considered from a time point of
administration of the compound to a time point at which the compound is no
longer
detectable in the organism or to any intermediate period of time between
administration
of the compound and a time at which it is no longer detectable in the organism
(e.g. due
to excretion); hence, a PK profile describes the bodily concentration in a
specific
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physiological system of a specific compound between administration and
dissipation, as
affected by the mechanisms of liberation, absorption, distribution, metabolism
and
excretion/secretion of the compound. Since each organism, and each individual
organism within a genus of an organism, reacts differently to the
administration of the
agent, a PK profile may be different, and in some cases highly variable from
subject to
subject, and may be different within an individual subject based on a current
physiological state, medical condition, environmental conditions and even the
time of
day.
According to some embodiments of the present disclosure, a pharmacokinetic
profile is achieved by providing a subject with one or more of:
A dose - a single amount of a compound or an agent that is being administered
thereto; and/or
A regimen ¨ a plurality of pre-determined doses that can be different in
amounts
or similar, given at various time intervals, which can be different or similar
in terms of
duration. In some embodiments, a regimen also encompasses a time of a delivery
period (e.g., agent administration period, or treatment period).
Alternatively, a regimen is a plurality of predetermined plurality pre-
determined
vaporized amounts given at pre-determined time intervals.
It is noted that the PK profile can be determined according to a change of a
PK
effect (parameter) as a function of time, or of a combination of PK effects a
function of
time.
A PK profile is typically assessed on a concentration on a time scale, using
directly and/or indirectly measured PK effects. For example, a PK profile may
be a
plasma concentration of a given pharmaceutically active agent in a subject as
a function
of time.
The term "pre-selected pharmacokinetic profile", as used herein, refers to a
PK
profile, which has been selected as desirable. A pre-selected PK profile may
be selected
since it has been found effective in accomplishing a desired pharmacodynamic
effect in
a subject, as described in any one of the respective embodiments (e.g., to
maintain a
subject within a therapeutic window, as described herein).
The terms "pharmacokinetic parameter", "pharmacokinetic effect", as used
herein interchangeably, refer to a measurable and quantifiable physiological
effect in a
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subject, which pertains to the presence of a pharmaceutically active agent in
a subject.
PK effects are direct or indirect expressions of a group of physiological
processes that
include absorption, distribution, metabolism, and excretion (ADME) of a
pharmaceutically active agent in a subject.
5 PK effects typically include, without limitation:
Ct, which is the concentration of an agent, as determined, measured or
assessed
in a specific physiologic system (e.g., in the plasma), after its
administration (delivery,
e.g., pulmonary delivery) of a dose or a regimen to a subject;
Cmax, which is the peak concentration of an agent, as determined, measured or
10 assessed in a specific physiologic system (typically in the plasma),
after its
administration to the subject;
Tmax, which is the time passed between administration and arriving at Cmax;
Area under the curve (AUC0õ; zero to infinity), which is the integral of the
concentration curve as a function of time, typically after a single dose or in
steady state;
15 Cam., which is the lowest concentration of the agent in the organism
before the
next dose is administered;
Tam., which is the time passed until Cnam is detected, or until the next dose
is
administered;
Ciast, which is the last observed quantifiable concentration;
20 kz, which is the terminal phase rate constant;
Elimination half-life (t1/2), which is the time required for the concentration
of the
agent to reach half of any selected value;
Elimination rate constant (kE), which is the rate at which an agent is removed
from the organism;
Administration rate (km), which is the rate of administration required to
balance
elimination;
Clearance, which is the volume of plasma cleared of the agent per unit time;
Bioavailability, which is the systemically available fraction of an agent; and
Fluctuation, which is the peak trough fluctuation within one dose, or one
regimen interval, at steady state.
As a tool for assessing the PK profile in a member of a population (a subject)
of
similar individual subjects (similar in the biological sense, as in a group of
humans), PK
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variables, which have been found to be correlated to a PK profile in a sub-set
of the
population, may be used to generalize (extrapolate) the PK profile for each of
the
individuals comprising the entire population.
The term "pharmacokinetic variable", as used herein, refers to a property of a
subject that is not necessarily dependent on a pharmaceutically active agent
or a method
of delivery a pharmaceutically active agent to a subject, and provide
information
pertaining to factors that affect the pharmacokinetic and pharmacodynamic
profiles of
an active agent in the subject.
Pharmacokinetic variables typically include, without limitation, body weight,
body height, body mass index (BMI), waist-to-hip ratio, lean body mass (LBM),
age
and gender, race, background illnesses, patient history (e.g. previous
exposure to the
agent or other agents) and concurrent medication. It is to be understood that
PK
variables depend on genetic and epigenetic composition of each individual
subject, and
therefore can be used to predict PK/PD profiles in an individual subject to a
certain
degree of accuracy. However, personalization/individualization of a treatment
based on
administration of a pharmaceutically active agent is typically based on
personal PK/PD
effects/parameters data acquisition that is used to determine the dose and
regimen for an
individual subject. In general, deviation of individual parameters from
average
parameters set for a wide population are notably small.
In the context of some embodiments of the present disclosure, the term
"treatment" refers to any one of: a single pulmonary administration of an
agent at a
given dose; a fixed and limited series of pulmonary administrations of an
agent, given at
the same or different doses at the same or different dose intervals (regimen);
a chronic
treatment which is administered as the limited series, but without a planned
termination
of the treatment (continuous treatment); and/or any combination thereof.
Typically, a
series of pre-determined doses given at pre-determined intervals, is referred
to herein as
a treatment regimen, or a regimen.
According to some embodiments of the method presented herein, pulmonary
delivering the agent comprises a single dose delivered as one pre-determined
vaporized
amount released by the MDI device in a single inhalation session or the dose
can be
administered to a patient as several concomitant inhalations. Alternatively, a
series of
doses, each administered in one or more pre-determined vaporized amount, and
given at
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a pre-determined time intervals, is referred to herein as a regimen. A regimen
is
therefore defined by one or more doses, administered in one or more pre-
determined
vaporized amounts, at pre-determined time intervals, wherein each of the pre-
determined vaporized amounts, the doses and the time intervals can be the same
or
different.
In the context of embodiments of the present disclosure, a PK profile of a
given
pharmaceutically active agent is a result of the dose and/or regimen by which
an agent
is administered to a patient, or, alternatively, according to some
embodiments, the PK
profile is a mean to afford a particular, a pre-selected or otherwise desired
pharmacodynamic profile of the agent in the patient.
As used herein, the term "pharmacodynamic profile" refers to the effect of a
pharmaceutically active agent in a subject as a function of time. Accordingly,
the term
"pharmacodynamic profile" refers to a sum of all biological expressions and
responses
of an organism as a function of time, upon administration of a
pharmaceutically active
agent. A pharmacodynamic profile is typically a direct or indirect result of
pharmacokinetic effect(s) at any given time point, or a pharmacokinetic
profile of the
agent in the patient, over any given time period.
A pharmacodynamic profile represents a change/variation of directly and/or
indirectly determined pharmacodynamic effect(s) as a function of time.
The terms "pharmacodynamic parameter", "pharmacodynamic effect", as used
herein interchangeably, refer to a group of effects pertaining to a subject
and a
pharmaceutical active agent, which are manifested in the subject upon
administering the
agent to the subject. Typically, pharmacodynamic parameters depend on the
subject's
PK variables and on the subject's PK effects.
Pharmacodynamic parameters can typically be determined by, without
limitation, a therapeutic (desirable) effect (e.g., personally perceived
therapeutic effect),
an adverse (undesirable) effect (e.g., a personally perceived adverse effect),
and by
means of determining a level of a biomarker (which is indicative of a
therapeutic and/or
an adverse effect), as these terms are described hereinbelow. A
pharmacodynamic
profile which can be a pre-selected (desired) pharmacodynamic profile,
according to
some embodiments of the present disclosure, is defined by the therapeutic
window of a
given agent in a given subject, as this term is defined herein.
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A pharmacodynamic (PD) profile is typically a time-dependent assessment
and/or measurement on a scale going from no response, through the onset of a
desired
therapeutic effect (below a therapeutic effect threshold), via the therapeutic
window,
through the onset of an adverse effect (above an adverse effect threshold),
and up to a
toxic effect.
According to some embodiments of the present disclosure, the pulmonary
delivering and/or the PK/PD study (measurement of any pharmacokinetic and/or
pharmacodynamic parameters) may optionally be conducted while monitoring at
least
one additional physiological parameter selected from the group consisting of:
a vital sign selected from the group consisting of a heart rate, an
oxygenation
level (Sp02), a blood pressure, a respiratory rate and a body temperature;
a pulmonary function selected from the group consisting of forced expiratory
volume (FEV1), maximum mid-expiratory flow (MMEF), diffusing capacity of the
lung
for carbon monoxide (DLCO), forced vital capacity (FVC), total lung capacity
(TLC)
and residual volume (RV);
a hematological marker selected from the group consisting of a hemoglobin
level, a hematocrit ratio, a red blood cell count, a white blood cell count, a
white blood
cell differential and a platelet count;
a coagulation parameter selected from the group consisting of a prothrombin
.. time (PT), a prothrombin ratio (PR) and an international normalized ratio
(INR);
a kidney function marker selected from the group consisting of a creatinine
clearance (CCr), a blood urea nitrogen level (BUN) and a glomerular filtration
rate
(GFR); and
a liver function marker selected from the group consisting of an aspartate
aminotransferase (AST) level, a serum glutamic oxaloacetic transaminase (SGOT)
level, an alkaline phosphatase level, and a gamma-glutamyl transferase (GGT)
level.
Accordingly, there is provided a method of recording at least one
pharmacokinetic effect and/or at least one pharmacodynamic effect, induced by
pulmonary delivering to a subject at least one pharmacologically active agent
being in a
.. plant material; the method is effected by:
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pulmonary delivering a pre-determined vaporized amount of the agent to the
subject from a metered dose inhaler device configured to vaporize the pre-
determined
vaporized amount of the agent upon controllably heating the plant material;
optionally, determining at least one pharmacokinetic effect in the subject at
pre-
determined time intervals before during and/or after the pulmonary delivering;
determining at least one pharmacodynamic effect in the subject at pre-
determined time intervals before during and/or after the pulmonary delivering;
wherein the pharmacodynamic effect is selected from the group consisting of a
desired effect, an undesired effect, a therapeutic effect, an adverse effect
and a level of a
biomarker.
Personalization:
As discussed hereinabove, some PK/PD studies or some parts thereof are based
on population parameters and on cohorts, yielding average or standardized dose
and/or
regimen data, while in reality a PK/PD profile may vary from patient to
patient, and
even within an individual patient, depending on a current physiological
condition,
mental state, medical condition and environmental conditions. Therefore, a pre-
determined vaporized amount of an agent (preset dose and/or regime) may be
found
inadequate for a particular individual at any given time and for any
individual reason.
Hence, in order to provide an optimized treatment for a given individual, in
any of the
methods presented herein, each of the pharmacokinetic and/or pharmacodynamic
parameter and/or variables may further be determined for an individual
patient, such
that the pre-determined vaporized amount is derived individually for the
patient.
It is noted that according to some embodiments of the present disclosure,
while a
patient may start the pulmonary delivering using an initial pre-determined
vaporized
amount which has not been determined based on the patient's
personal/individual
parameters and variables, the method includes an optional step at which the
patient's
personal parameters and variables are considered in the determination of the
pre-
determined vaporized amount. Thus, according to some of any of the embodiments
of
the present disclosure, the method may include personalization of the pre-
determined
vaporized amount that affords the pre-selected PK/PD profile. The
personalization step
presented below can replace a pre-calibration of the MDI device; or as a
complementary
step after calibration of the MDI device.
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Accordingly, the pharmacokinetic effect(s) and/or the pharmacokinetic
variable(s) and/or the pharmacodynamic effect(s) are independently determined
for an
individual patient, such that the pre-determined vaporized amount is
determined
personally for that patient. It is noted herein that a personal
pharmacokinetic parameter
5 can be
obtained directly by conducting a PK study in the patient by monitoring the
concentration of the agent in the patient (e.g., using blood samples and/or
other means),
or by applying a calculation based on personal PK variables and other personal
variables that may have an effect on the PK/PD profiles in that patient.
Alternatively, according to some of any of the embodiments of the present
10
disclosure, the method may include collecting, observing or otherwise
monitoring and
determining at least one personal pharmacodynamic effect and/or
pharmacokinetic
effect in an individual subject so as to determine if pulmonary delivering the
initial pre-
determined vaporized amount of the agent exhibits the pre-selected (desirable)
pharmacodynamic and/or pharmacokinetic profile;
15 if
pulmonary delivering the pre-determined vaporized amount of the agent does
not exhibit the pre-selected/determined pharmacodynamic and/or pharmacokinetic
profile, determining an adjusted vaporized amount of the agent that exhibits
the pre-
selected pharmacodynamic and/or pharmacokinetic profile; and
adjusting, resetting, re-calibrating or otherwise re-configuring the device to
20 deliver
an adjusted vaporized amount, whereby, upon re-configuring the MDI device,
the adjusted vaporized amount being now the pre-determined vaporized amount.
According to some embodiments of the present disclosure, the personalization
of
the pulmonary delivering and/or the PK/PD study may optionally be conducted
while
monitoring at least one additional physiological parameter, as described
herein.
25
Optionally, monitoring at least one pharmacokinetic effect and/or at least one
pharmacodynamic effect induced by the agent in the subject is carried out at
pre-
determined time intervals before, during and/or after the pulmonary
delivering.
According to some embodiments, monitoring of a pharmacokinetic effect and/or
a pharmacodynamic effect is carried out by receiving data indicative of these
effects in
the subject from at least one sensor being in communication with a controller,
as these
terms are discussed hereinbelow, associated with the inhaler device presented
herein.
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It is noted that a personal pharmacodynamic parameter can be a personally
perceived therapeutic effect, a personally perceived adverse effect and a
(level or
presence of a) biomarker obtained and/or measured in the individual patient.
According
to some embodiments, the acquisition/determination of the personally perceived
therapeutic effect, the personally perceived adverse effect and/or the
biomarker may be
conducted voluntarily by the patient, or involuntarily by automatic means. The
method,
according to some embodiments thereof, is then effected by determining an
adjusted
vaporized amount of the agent based on the personal pharmacodynamic parameter,
and
configuring the device to deliver the adjusted vaporized amount; whereby the
adjusted
vaporized amount is the pre-determined vaporized amount. In other words, the
adjusted
vaporized amount is the personalized pre-determined vaporized amount, which is
based
on personal pharmacodynamic parameters obtained for an individual patient,
after being
administered a pre-determined vaporized amount determined for a general
population
and using population PK variables. Alternatively, an expected response can be
used as
a parameter for confirming the identity of a user. For example, a user is
instructed to
perform a task at a given time before and/or after administration, and the
measured
value is compared with a comparable expected value recorded for the same user,
optionally under similar circumstances.
Personally Perceived Effect:
A "personally perceived effect" is a subjective assessment of a patient
pertaining
to an effect of a given' agent or treatment in the patient's body. The
personally
perceived effect may include one or more of a personally perceived therapeutic
effect or
a personally perceived adverse effect.
A psychotropic effect optionally corresponds to a symptom that can be
perceived by the patient. It is noted that in some cases a psychotropic effect
may not be
accurately perceived by the patient. Examples of psychotropic symptoms
include,
without limitation, paranoia, anxiety, panic attack, euphoria, pseudo-
hallucinatory,
sedation, conscious perception variation, joviality, metacognition and
introspection, an
enhanced recollection (episodic memory), amnesia, a sensuality variation, a
variation in
awareness of sensation and a variation in libido, dizziness, ataxia, euphoria,
perceptual
alterations, temporal distortion, intensification of ordinary sensory
experiences, short
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term memory, and attention, impaired reaction, skilled activity, verbal
fluency,
dependence, melancholy and depression.
A somatic effect sometimes corresponds to a symptom which can be perceived
by the patient or measured thereby. Examples for somatic symptoms include,
without
limitation, pain, migraine, nausea, dry mouth and a sensation of cold or hot
hands and
feet, increased heart rate, increased cerebral blood flow (e.g., migraine
symptoms, "head
pressure"), dilation of bronchial passages (e.g., coughing and difficulty
breathing),
dilation of blood vessels (e.g., shivers, skin redness, blushing), eye redness
and pupil
dilation, dry mouth, thirst, hunger or food craving.
Desired effects - Therapeutic effects:
A "personally perceived therapeutic effect" is a subjective assessment of a
patient pertaining to a beneficial (desired) effect of a given agent in the
patient's body.
In some embodiments, a desired effect includes a relief of a symptom and/or an
alleviation of cause of a medical condition. For example, if the desired
therapeutic
effect is defined as an alleviation of pain, the patient may report a level of
pain by
means of a pain scale evaluation protocol. A pain scale protocol measures a
patient's
pain intensity and/or other features. In the context of embodiments of the
present
disclosure, a pain scale protocol is based on self-report (subjective),
observational
and/or behavioral data provided by the patient, while physiological data falls
under the
definition of biomarkers, namely objective data. In general, all personally
perceived
(subjective) assessments by a patient can be used as feedback for self-
titration and
personalization of a treatment.
A personally perceived therapeutic effect may be associated with or
corresponds
to, directly or indirectly, a symptom of the medical condition which the
patient is being
treated for. In some cases a patient may perceive a change in the perceived
level of the
symptom, and when the symptom of the medical condition is alleviated (a
diminution in
the level of the symptom), the person perceives this change as a therapeutic
effect of
agent delivered during the treatment. Hence, according to embodiments, a
personally
perceived therapeutic effect corresponds to a reduction in a level of a
symptom such as,
but not limited to, pain, migraine, depression, cognitive function deficit,
attention
deficit, hyperactivity, anxiety disorders, diarrhea, nausea, vomiting,
insomnia, delirium,
appetite variations, sexual dysfunction, spasticity, increased intra ocular
pressure,
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bladder dysfunction, tics, Tourette symptoms, posttraumatic stress disorder
(PTSD)
symptoms, inflammatory bowel disease (IBD) symptoms, irritable bowel syndrome
(IBS) symptoms, hyper tension, hemorrhagic symptoms, septic and cardiogenic
shock,
drug addiction and craving, withdrawal symptoms, tremors and other movement
disorders symptoms.
In some embodiments, a personally perceived therapeutic effect may include an
effect that is not associated with or corresponds to, directly or indirectly,
a symptom of
the medical condition which the patient is being treated for, but is
nonetheless beneficial
to the patient's experiencing such symptom. For example, when a symptom
includes a
form of discomfort (for example pain or nausea), a patient may benefit from a
psychoactive state in which the discomfort may be less prominent or more
tolerable.
One example of such a desired effect is causing temporary moderate stupor
during pain.
In some embodiments, the same effect may be therapeutic or adverse, depending
on a
degree thereof and/or timing thereof and/or other circumstances.
Undesired effects - Adverse effects:
A "personally perceived adverse effect" is associated with an emergence and/or
an increase in the level of an undesired symptom that is not necessarily
associated with
the medical condition being treated, since it is caused, directly or
indirectly, by a
pharmacokinetic parameter of the pharmaceutically active agent being delivered
to the
patient.
According to some embodiments, a personally perceived undesired effect can be
a mental effect, a psychotropic effect and/or a somatic effect, wherein the
mental and/or
psychotropic effect is mostly related to CNS activity which encompasses
perception,
consciousness, cognition and behavioral effects, and the somatic effect
relates to all
other bodily systems, and include, without limitation, gastro-intestinal,
neuromuscular,
cardiovascular, convulsive, endocrine effects and the like.
A personally perceived adverse effect is a subjective assessment of the
patient
pertaining to the adverse effect of a given agent in the patient's body. In
general, all
personally perceived (subjective) adverse effect assessments by the patient
can be used
as feedback for personalization of the treatment and self-titration.
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Biomarkers:
While perception of an effect is a subjective assessment of the effect, and
typically complicated to quantify, a biomarker is a more objective and
typically
measurable quantitative assessment of an effect. Thus, the term "biomarker",
as used
herein, is a measurable indicator of the PD profile at a given time point, and
typically
consists of a direct and/or indirect somatic, biologic and/or chemical
manifestation of
the therapeutic effect and/or an adverse effect. In other words, a biomarker
is any
objectively measurable quantity that can be used as an indicator of the state
of a medical
condition, the effect of a particular agent on the state of a medical
condition, or another
physiological state of an organism. It is note that some of the
therapeutic/adverse
effects can only be assessed qualitatively, and some can be assessed
indirectly by, for
example, measuring an impaired reaction by applying a performance test.
In the context of embodiments of the present disclosure, biomarkers are
divided
into the group of invasively-detected biomarkers and the group of non-
invasively-
detected biomarkers. In general, all biomarker data (objective) collected in
the patient
by any mean, observation measurement, sensor measurement and the likes, can be
used
as feedback for personalization of the treatment and self-titration. It is
noted that some
invasively-detected biomarkers can be detected and measured non-invasively and
vice
versa.
Examples for non-invasively-detected biomarkers include, without limitation,
heart rate, oxygenation level (Sp02), blood pressure, respiratory rate, body
temperature,
inhalation volume, facial expressions, involuntary skeletomuscular responses
(ataxia,
tremors, muscle twitches, cramps, spasms etc.), voluntary motor skills,
sweating, hand-
eye coordination, eye vascular expansion, reddening of the conjunctiva and/or
sclera,
variations in intra-ocular pressure, sinus tachycardia, cardiac arrhythmias,
skin
conductance/impedance levels, seizures, electromyography (EMG),
electrocardiogram
(ECG), photo-plethysmogram (PPG), galvanic skin response (GSR), Blue-Brown
visual
inhibition, H-mask visual inhibition, Auditory Latent inhibition, Visual
Latent
inhibition, Stroop colour word, Simple reaction (conflict task), Cognitive Set
switching,
Logical reasoning, Decision making time, Rapid info processing, Perceptual
maze,
Simulated driving, Visual search, Time estimation, Time perception, Visual
search,
Attentional search, Symbol copying, Letter cancellation, Alphabetic cross-out,
D2
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cancellation, Brickenkamp D2, digit copying test (DDCT), symbol-digit
substitution
(SDST), digit-symbol substitution test (DSST), Digit Vigilance, Vigilance,
Auditory
vigilance test, Wesnes/Warburton Vigilance task, Rapid info processing,
CRT+Tracking Divided attention, Selective attention, Focused attention Task,
5 Emotional attention Task, Auditory Flutter fusion, Flash fusion, critical
flicker fusion
(CFF), Continuous attention, Paired associate learning, Wordlist learning, 15
word
test, Introductory conditioning, Delayed word recall, Delayed word
recognition,
Delayed picture recognition, Word presentation, Word recognition, Numeric
working
memory, Numerical memory, Memory scanning, Auditory Brown/Peterson, Visual
10 Brown/Peterson, Visual spatial memory, Fragmented picture test, Pauli
test, Block
Span, Digit span, Digit Span (forward), Digit Span (backward), WAIS
vocabulair, WAIS similarity, Word fluency, Verbal fluency, Performance time
(Delayed word recogn.), Performance time (Numeric working memory), Performance
time (Digit vigilance), Performance time (Rapid info processing), Performance
time
15 (Delayed picture recognition), Performance time (Visual information
processing),
Simple Reaction Time CRT, Complex RTvisual, Visual choice RT, VRT, Visual
response speed, ART, Acoustic RT, Wire Maze Tracing, Archimedian spiral,
Critical
tracking task, Trail making, Tracking Complex, Tracking Wiener Geraet,
Flexibility of
closure, WAIS block design, WAIS picture comparison, Digit copying,
Manipulative
20 motor, Feinmotorik, Graphological analysis, tapping, Hand arm lateral
reach
coordination, Visual arm random reach, Motor control & coordination, Motor
behavior
and EEG.
Comprehensive descriptions of non-invasively-detected biomarkers, in the
context of pharmaceutically active agents derived from cannabis, include,
without
25 limitation, a study by Zuurman, L. et al. [British Journal of Clinical
Pharmacology,
2009, 67(1), pp. 5-21], which is incorporated herein by reference as if full
set forth
herewith.
In the context of some embodiments of the present disclosure, assessment,
observation or recordation of a personally perceived desired/therapeutic
effect and/or a
30 personally perceived undesired/adverse effect can be used at any time,
including when a
non-invasive biomarker is not available to the patient or the practitioner in
order to
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conduct monitoring of PD effects for a defining a pre-determined vaporized
amount
during initial calibration, and/or for adjusting the amount during self-
titration or
personalization of the device used in treatment. Alternatively, a user or a
practitioner
may choose not to use a non-invasive biomarker for any reason. Optionally, an
invasive
biomarker measuring device may be used for monitoring amount at least one
pharmacokinetic effect and/or at least one pharmacodynamic effect induced by
the
agent in the patient, especially if already installed in or on the patient,
which can be
accessed and provide the required information. In some embodiments at least
two of a
perceived effect, a non-invasive biomarker and an invasive biomarker are used
to
measure and/or estimate the same or different PD effects induced in a user by
the one
or more pharmaceutically active agents. It is noted that sensors for
monitoring PD
effects may be used as part of a manual and/or automatic feedback process for
determining and/or adjusting a pre-determined vaporized amount of an agent off-
line or
in real-time.
As used herein, the term "real-time" refers to a reference (recordation,
detection,
measurement, reporting, depiction, reaction etc.) to an event or a series of
events,
wherein the reference occurs essentially at the same time and/or at the same
rate, as the
event(s). By "essentially at the same time and/or at the same rate" it is
meant that a
single event and its corresponding reference are temporally separated by a
response time
that ranges between zero to 30 minutes (0-30 minutes), 0-20 minutes, 0-10
minutes, 0-5
minutes, 0-1 minute, 0-45 seconds, 0-30 seconds, 0-20 seconds, 0-10 seconds, 0-
5
seconds, 0-1 second, 0-750 milliseconds, 0-500 milliseconds, 0-250
milliseconds, 0-100
milliseconds, 0-50 milliseconds, 0-10 milliseconds or 0-1 millisecond.
Optionally, "real-time" refers to a reference (recordation, detection,
measurement, reporting, depiction, reaction etc.) to an event or a series of
events,
wherein the reference occurs essentially between administration of an active
agent to the
dissipation of at least one pharmacodynamic effect induced in the subject by
the
administered agent. In some embodiments, "real-time" refers to a reference to
an event
or a series of events, occurring between two drug delivery inhalation events
scheduled
to occur between administration of an active agent to the dissipation of at
least one
pharmacodynamic effect induced in the subject by the administered agent.
Optionally,
the "real-time" event or series of events includes adjusting of the timing
and/or amount
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of the later drug delivery inhalation event according to data indicative of
one or more
effect(s) of the earlier drug delivery inhalation event. In some embodiments,
such
dissipation means that the effect reaches a degree that is below detection for
a given
sensor and/or for being perceived by the user, as the case may be.
In the context of embodiments of the present invention, the term "real-time
measurement" refers to a reference made by a sensor in response to an event
that takes
place in a subject in communication with the sensor. In some embodiments, a
real-time
measurement is a continuous, sporadic, regular or systematic monitoring,
reporting,
recordation, analysis, processing, presenting, displaying and transmitting of
a
pharmacodynamic effect by a designated sensor that is in communication with a
subject.
While some PD effects are essentially subjective, such as the self-reported
level
of a symptom, the determination of some PD effects have been standardized so
as to
confer objectivity or at least afford a comparative scale that can be
generalized across a
population of subjects, as in the case of pain scales, wherein a change in the
pain level is
considered as a PD effect.
Invasively-detected biomarkers include any indicator that requires a sensor to
be
placed inside the body of the patient, including skin penetration, or requires
a sample
taken from within the body of the patient in order to quantify the indicator.
For
example, blood extraction from a vein of the patient using a needle, or via
skin pricking,
in order to measure the concentration of any indicator or factor (biomarker),
is regarded
as an invasive measurement, and thus these biomarkers are regarded as
invasively-
detected biomarkers.
Self-Titration:
In cases where a patient experiences for any reason inadequacy of a preset
dose
and/or regimen, regardless if the pre-determined vaporized amount of the agent
(the
preset dose and/or regimen) have been derived individually for that patient or
not, this
patient may wish to readjust the pre-determined vaporized amount of the agent
(dose
and/or regimen) according to a current physiological condition, a mental
condition, or
for any other reason. This option is regarded as self-titration of the agent,
and be part of
.. a manual feedback process for determining a pre-determined vaporized amount
of an
agent.
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Hence, when the PD profile requires re-selection, the pulmonary delivery of
the
active agent from the MDI device further includes steps that allow the patient
to self-
titrate the pre-determined vaporized amount, or a practitioner to alter and
readjust the
pre-determined vaporized amount of the agent as needed.
According to some of any embodiments of the present disclosure, the pulmonary
delivering of the pharmaceutically active agent further includes configuring
the device
to deliver an adjusted vaporized amount of the agent, whereas the adjusted
vaporized
amount is selected so as to exhibit a re-selected pharmacodynamic profile of
the agent
in the patient, whereby, upon the configuring, the adjusted vaporized amount
becomes
the pre-determined vaporized amount and the re-selected pharmacodynamic
profile is
regarded as a pre-selected pharmacodynamic profile.
In some embodiments, the readjustment is effected without re-determining a PK
and/or a PD effect in the patient.
Automatic feedback:
According to some embodiments, the adjustment or re-adjustment of the pre-
determined vaporized amount of an agent (dose and regimen thereof) includes an
automatic feedback process based on personal pharmacodynamic parameter data.
Personal pharmacodynamic parameter data optionally include at least one
personally perceived therapeutic effect and at least one personally perceived
adverse
effect; and may further include at least one biomarker level datum.
As discussed hereinabove, the automatically obtained level of a biomarker may
be an invasively-detected biomarker and a non-invasively-detected biomarker.
According to embodiments of the present disclosure, the automatically obtained
level of
a biomarker is that of a non-invasively-detected biomarker.
Thus in some of any of the embodiments of the present disclosure, the method
further includes:
automatically measuring, acquiring or otherwise determining at least one
personal pharmacodynamic parameter in the patient in the form of a perceived
therapeutic and/or perceived adverse effect and/or a level of at least one
biomarker,
collectively referred to herein as personal pharmacodynamic feedback data or
information;
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automatically re-determining an adjusted vaporized amount of the agent based
on the automatically acquired personal pharmacodynamic feedback data, or in
general
adjust the dose and regimen according to the acquired personal pharmacodynamic
feedback data;
automatically configuring the device to deliver the adjusted vaporized amount,
to thereby exhibit a pre-selected or a re-selected PK and/or PD profile in the
patient;
whereby for that particular person, the adjusted vaporized amount becomes the
pre-determined vaporized amount of the pharmaceutically active agent and the
re-
selected PK and/or PD profile becomes the pre-selected PK and/or PD profile.
It is noted herein that automatic determination of any PD effect, or the
automatic
determination of the vaporized amount of the pharmaceutically active agent,
can be
fully or partially applied in any of the embodiments of the present
disclosure, including
the initial calibration of the MDI device, the re-configuration of the device
during the
personalization process, and/or the self-titration process.
Co-administration:
It is noted herein that the method and/or device, according to some of any
embodiments of the present disclosure, is suitable for pulmonary delivering of
more
than one pharmacologically active agent to a patient, wherein the device is
configured to
deliver independently a pre-determined vaporized amount of each the agents
controllably, accurately and reproducibly.
According to some embodiments, co-administration of more than one active
agent is carried out so as to achieve a desired balance between therapeutic
(desired;
positive; wanted) effects and adverse (undesired; negative; unwanted) effects.
Such
balance may be achieved for example when one active agent, while having some
or no
direct therapeutic effect, has the capacity to lower an adverse effect caused
by the other
co-administered active agent. In another example, different active agents
induce similar
and cumulative desired effects and different non-cumulative undesired effects;
in which
case such two such agents can be co-administered to induce a cumulative (e.g.,
double)
desired effect while inducing substantially lower (e.g., single) undesired
effect,
compared to a 2-fold dose of each given individually. Optionally, the second
agent has
an effect that reduces and/or changes the nature of an adverse effect of the
first agent.
In such cases, the amount of the first agent (and the desired effect itself)
may be
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increased, without increasing, and optionally while decreasing, the undesired
effects
thereof. This approach allows a higher dose for achieving a desired effect in
treatment
while maintaining low levels of adverse effects.
According to some embodiments, these two or more agents can be contained in
5 the same substance or in more than one substance. In some embodiments, at
least one
of the agents is in at least one plant material. Hence, according to some
embodiments,
the device and method presented herein are configured for delivering each of
at least
two pharmacologically active agents independently at a pre-determined
vaporized
amount, wherein the substance being heated in the device comprises both or all
these
10 .. pharmacologically active agents. Alternatively, the device comprises
more than one
substance, which comprises the pharmacologically active agents.
In some embodiments, a method of pulmonary delivering to a subject at least a
first pharmacologically active agent and a second pharmacologically active
agent is
provided, wherein at least one of the agents being in at least one plant
material; the
15 method is carried out by independently delivering the agents to the
subject using a
metered dose inhaler device configured to vaporize at least a first pre-
determined
vaporized amount of the first agent and at least a second pre-determined
vaporized
amount of the second agent upon controllably heating the plant material,
wherein
heating is effected such that the first pre-determined vaporized amount is
delivered to
20 the subject successively, concomitantly and/or at least partially
overlapping with the
second pre-determined vaporized amount, and wherein each of the pre-determined
vaporized amounts of each of the agents induces in the subject independently
at least
one pharmacokinetic effect and/or at least one pharmacodynamic effect.
According to an aspect of some embodiments of the present disclosure, there is
25 provided a method of pulmonary delivering to a subject at least a first
pharmacologically active agent and a second pharmacologically active agent, at
least
one of which being in at least one plant material; the method is carried out
by:
independently delivering the agents to the subject using a metered dose
inhaler
device configured to vaporize at least a first pre-determined vaporized amount
of the
30 first agent and at least a second pre-determined vaporized amount of the
second agent
upon controllably heating the at least one plant material,
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wherein heating is effected such that the first pre-determined vaporized
amount
is delivered to the subject successively, concomitantly and/or at least
partially
overlapping with the second pre-determined vaporized amount, and wherein each
of the
pre-determined vaporized amounts of each of the agents induces in the subject
independently at least one pharmacokinetic effect and/or at least one
pharmacodynamic
effect.
A pulmonary delivery of more than one active agent to a subject (a patient) is
generally known in the art as co-administration. The term "co-administration"
as used
herein, refers to a concomitant administration of more than one active agent
to a subject,
whereas in the context of embodiments presented herein, the term "concomitant"
means
that the co-administered active agents are present in the subject (PK), or
otherwise
induce an effect (PD), at similar, identical or partially overlapping periods
of time. In
some embodiments, the time interval between delivering at least one agent
(first) and
delivering at least one other agent (second) ranges between zero minutes to 30
minutes.
In the context of co-administration of more than one active agent, the terms
"substantially simultaneous" and "rapid succession" correspond to the term
"concomitant" and "partially overlapping", as used herein, namely meaning that
the
period of time between an inhalation of a first agent and an inhalation of a
second agent
is sufficiently short to be regarded as a single inhalation. Optionally, a
number of
inhalations takes place within 5-30 minutes. Optionally, each inhalation in
such "rapid
succession" delivers to the user a different amount or a composition of one or
more
pharmaceutically active agents. Optionally, two or more of the inhalations
provide the
same composition and amount of the one or more pharmaceutically active agents.
In
some embodiments, an inhalation of a second agent is performed at such timing
that a
first active agent inhaled previously still induces at least one PD effect in
the subject. In
some embodiments, co-administration of more than one active agent by delivery
thereof
in rapid succession means that the inhaled agents have essentially the same
effect as
they would have had if inhaled in a single inhalation.
According to some embodiments, a time interval between delivering the first
agent and delivering the second agent ranges between zero minutes to 30
minutes.
According to some embodiments, each of these agents can be delivered at a pre-
determined vaporized amount. Hence, the device and the method presented herein
are
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capable of and designed for delivering the plurality of pre-determined
vaporized
amounts, wherein these vaporized amounts may be the same or different.
According to some embodiments, each of these agents can be delivered at a pre-
determined time interval. Hence, the device and the method presented herein
are
capable of and designed for delivering the plurality of pre-determined
vaporized
amounts at pre-determined time intervals, wherein these time intervals may be
the same
or different.
According to some embodiments, the device and method presented herein are
capable of and designed for delivering a plurality of pre-determined vaporized
amounts
of each of the pharmacologically active agents, wherein the pre-determined
vaporized
amounts and the pre-determined time intervals may each be the same or
different from
one another.
In some embodiments, the co-administration is based on interdependencies
between one or more PD effects induced by individual agents, namely a PD
effect of
one agent influences the level of a PD effect induced by the other agent. For
example,
in some embodiments, the pre-determined vaporized amounts of the first agent
affects a
level of the pharmacodynamic effect induced by the second agent. Optionally,
the pre-
determined vaporized amount of the first agent increases a level of a desired
effect
induced by the second agent (potentiation). Optionally, the pre-determined
vaporized
amount of the first agent reduces a level of the undesired effect induced by
the second
agent. Optionally, the first agent and the second agent induce a desired
effect
synergistically.
In some embodiments, the method of pulmonary delivering more than one active
agent, a presented hereinabove, further includes:
adjusting at least one of the first pre-determined vaporized amount and the
second pre-determined vaporized amount so as to achieve the pre-determined
pharmacokinetic effect and/or the pre-determined pharmacodynamic effect based
on
data indicative of at least one pharmacokinetic effect and/or at least one
pharmacodynamic effect induced by the agent in the subject.
In some embodiments, the method further includes generating indicative data by
monitoring at least one pharmacokinetic effect and/or at least one
pharmacodynamic
effect induced in the subject by at least one of the first agent and the
second agent.
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According to an aspect of some embodiments of the present disclosure, there is
provided a method of vaporizing at least a first pharmacologically active
agent and a
second pharmacologically active agent, at least one of which being in at least
one plant
material and being suitable for pulmonary delivery to a patient, which is
carried out by
using a metered dose inhaler device configured to vaporize at least a first
pre-
determined vaporized amount of the first agent and at least a second pre-
determined
vaporized amount of the second agent upon controllably heating the plant
material,
wherein upon pulmonary delivering the agents to the subject, the heating is
effected
such that the first pre-determined vaporized amount is delivered to the
subject
successively, concomitantly and/or at least partially overlapping with the
second pre-
determined vaporized amount, and wherein upon pulmonary delivering the agents
to the
subject, each of the pre-determined vaporized amounts of each of the agents
induces in
the subject independently at least one pharmacokinetic effect and/or at least
one
pharmacodynamic effect.
According to an aspect of some embodiments of the present disclosure, there is
provided a use of a metered dose inhaler device for vaporizing at least a
first
pharmacologically active agent and a second pharmacologically active agent, at
least
one of which being in at least one plant material and being suitable for
pulmonary
delivery to a patient, wherein the device is configured to vaporize at least a
first pre-
determined vaporized amount of the first agent and at least a second pre-
determined
vaporized amount of the second agent upon controllably heating the plant
material, and
wherein upon pulmonary delivering the agents to the subject, the heating is
effected
such that the first pre-determined vaporized amount is delivered to the
subject
successively, concomitantly and/or at least partially overlapping with the
second pre-
determined vaporized amount, and wherein upon pulmonary delivering the agents
to the
subject, each of the pre-determined vaporized amounts of each of the agents
induces in
the subject independently at least one pharmacokinetic effect and/or at least
one
pharmacodynamic effect.
Method of treatment
According to an aspect of some embodiments of the present disclosure, there is
provided a method of treating a patient suffering from a medical condition
that is
treatable by pulmonary delivering a vaporizable pharmaceutically active agent.
The
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method, according to some of any of the embodiments of the present disclosure,
is
carried out by pulmonary delivering the agent to the patient from a metered
dose inhaler
device configured to release at least one pre-determined vaporized amount of
the agent
upon controllably heating a solid form of a substance comprising the agent.
According
to some embodiments, the pre-determined vaporized amount of the agent is
selected to
exhibit at least one pre-selected pharmacokinetic profile and/or at least one
pre-selected
pharmacodynamic profile of the agent in the patient.
Non-limiting representative medical conditions, treatable by pulmonary
delivering a vaporizable pharmaceutically active agent, include neuropathic
pain,
phantom pain, nociceptive pain, psychogenic pain (psychalgia or somatoform
pain),
asthma, chronic obstructive pulmonary disease (COPD), Crohn's disease,
multiple
sclerosis (MS), generalized epilepsy with febrile seizures plus (GEFS+),
spasticity,
Dravet's Syndrome, seizures, epilepsy, psychiatric disorders, anxiety
disorders,
posttraumatic stress disorder (PTSD), insomnia, delirium, increased intra
ocular
pressure, bladder dysfunction, tics, Tourette symptoms, appetite variations,
sexual
dysfunction, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS),
hyper
tension, septic and cardiogenic shock, drug addiction and craving, tremors and
other
movement disorders.
According to some of any of the embodiments of the present disclosure, the
method is carried out by use of an MDI device which is configured to release a
pre-
determined vaporized amount such that a deviation of an actual vaporized
amount of the
agent, from the pre-determined vaporized amount of the agent, is 20 % or less,
15 % or
less, 10 % or less, or 5 % or less of the pre-determined vaporized amount.
According to some of any of the embodiments of the present disclosure, the
method is carried out such that a deviation of an actual pharmacokinetic
profile from the
pre-selected pharmacokinetic profile is 40 % or less than of the pre-selected
pharmacokinetic profile. Alternatively, the deviation is 35 % or less, 30 % or
less, 25 %
or less, or 20 % or less. It is noted that the deviation can be in the
pharmacokinetic
profile or in one or more pharmacokinetic parameters composting the profile,
e.g., C, or
Cmax. Such deviations are expected to be low due to the low inter-variability
of PK
effects obtained when using an accurate, consistent and precise MDI device.
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According to some of any of the embodiments of the present disclosure, the
method is carried out such that a deviation between the perceived PD profile
from the
pre-selected PD profile at any given time point is 25 % or less, 20 % or less,
15 % or
less, 10 % or less, or 5 % or less. The deviation between the perceived PD
profile from
5 the pre-
selected PD profile at any given time point can be assessed by determining a
PD
effect, as discussed hereinabove. The deviation is expected to be low also due
to the
low inter-variability of PK effects discussed hereinabove.
Since the device can be configured to deliver any accurate amount consistently
so as to exhibit a pre-selected or pre-determined PD effect in the patient,
the device and
10 the method presented herein can effect a pre-selected or pre-determined PD
profile
which can be finely controlled so as to be:
within a level lower than a minimal level of a desired effect (for example
below
the therapeutic window);
ranging within a minimal level of said desired effect to a maximal level of
said
15 desired
effect in which an undesired effect is tolerable and/or acceptable, namely
substantially low or not exhibited or not perceived (for example within the
therapeutic
window;); and
within a level higher than a minimal level an undesired effect (for example
above the therapeutic window).
20 In some
embodiments, a minimal level of an adverse effect correlates to a
maximal level of a therapeutic effect in which an adverse effect is not
detected or
perceived.
In some embodiments, the level of the pharmacodynamic profile that is higher
than the minimal level of an adverse effect, is one wherein the higher level
of the
25 adverse
effect is an acceptable level of the adverse effect. Any one of personal,
medicinal and legal factors may determine the acceptability of the level of
the adverse
effect, such as, for example, personal preference, habits and endurance,
pharmaceutical
and professional safety considerations, as well as legal and social
consideration.
In some embodiments, a "minimal level of a therapeutic effect" means a
30 minimal
detectable therapeutic effect. Optionally, such a minimal level is at least
sufficient to justify treating a person with a given dose and/or regimen with
one or more
substances. Such justification may be based on, for example, the type and
severity of
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adverse effects and on the effect that the treatment may have at the minimal
level on the
wellbeing of the patient. Optionally, the minimal therapeutic effect means a
minimal
effect that is perceived by the individual being treated. Optionally,
justification for
administering a dose and/or regimen aiming to achieve PK/PD effects below the
therapeutic window may be to achieve a prophylactic treatment or reduce the
consequences of an acute pain (breakthrough pain) and/or to prevent emergence
of
tolerance to the treatment.
As discussed hereinabove, according to some of any of the embodiments of the
present disclosure, the pre-selected PD profile corresponds to the therapeutic
window of
the agent in the patient, namely ranges within a minimal level of the
therapeutic effect
to a maximal level of the therapeutic effect in which an adverse effect is
acceptable.
At any pre-selected PD profile, the method and device provide high accuracy
and reproducibility; hence, according to some of any of the embodiments of the
present
disclosure, the deviation of the perceived pharmacodynamic profile from the
pre-
selected pharmacodynamic profile at any given time point is 25 % or less, 20 %
or less,
10 % or less or 5 % or less below the pre-selected PD profile, and/or 25 % or
less, 20 %
or less, 10 % or less or 5 % or less above said pre-selected PD profile.
A non-limiting examples of a medical condition treatable by pulmonary
delivering a vaporizable pharmaceutically active agent, is pain, which is
treatable by
THC vaporized from cannabis.
A metered dose inhaler (MDI) device:
According to another aspect of some embodiments of the present disclosure,
there is provided a metered dose inhaler (MDI) device configured for pulmonary
delivery of a pre-determined vaporized amount of at least one
pharmacologically active
agent to a patient, wherein:
the device is configured to deliver said pre-determined vaporized amount of
said
agent upon controllably heating a solid form of a substance comprising said
agent;
the pre-determined vaporized amount is selected such that it affords a pre-
selected pharmacokinetic profile and/or a pre-selected pharmacodynamic profile
of the
agent in the patient; and
the pre-determined vaporized amount is derived by measuring at least one
pharmacokinetic parameter and/or at least one pharmacodynamic parameter
induced by
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the pulmonary delivering of the agent in the patient from the MDI device
(PK/PD
studies).
According to an aspect of some embodiments of the disclosure, there is
provided
a method for controlling a metered dose inhaler; the method is effected by:
heating plant material so as to vaporize at least one pre-determined vaporized
amount of at least one pharmacologically active agent being in the plant
material; and
controlling the pre-determined vaporized amount based on data indicative of at
least one pharmacodynamic effect induced by the agent in the subject.
According to an aspect of some embodiments of the disclosure, there is
provided
a method of operating an MDI for pulmonary delivering to a subject of at least
one
pharmacologically active agent being in a plant material; the method is
effected by:
selecting at least one pre-determined vaporized amount of the agent so as to
achieve at least one pre-determined pharmacokinetic effect and/or at least one
pre-
determined pharmacodynamic effect induced by the agent in the subject; and
vaporizing, the at least one pre-determined vaporized amount of the agent
using
the metered dose inhaler device for controllably heating the plant material.
According to some embodiments of the invention, the MDI device is further
configured for communication with a patient interface circuitry and be
integrated in a
system designed to allow PK/PD data acquisition and input, patient records'
storage,
automatic or manual calibration, adjustment, resetting and re-determination of
the initial
presetting of the device by the patient and/or by a practitioner, as will be
described in
details hereinbelow.
According to some of any of the embodiments of the present disclosure, the
method and device presented herein are also characterized by a high accuracy,
consistency, precision and reproducibility, which are expressed by a minimal
deviation
between the actual vaporized amount of the agent being inhaled by the patient,
and the
pre-determined vaporized amount of the agent.
According to some of any of the embodiments of the present disclosure, the
MDI device for controlled vaporization of at least one active pharmaceutically
active
agent from at least one type of substance by application of heat, comprises:
At least one cartridge (also referred to herein as a "dose unit") containing a
substance that comprises at least one active pharmaceutically active agent;
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a heating element adapted to apply heat to the substance to vaporize the
pharmaceutically active agent; and
a mechanism adapted for moving the cartridge relative to a controller for
powering the heating element.
In an embodiment of the invention, the device further comprises substance
organized as plurality of cartridges arranged in a tape, a daisy or a
magazine, the
substance comprising the active pharmaceutically active agent. Optionally, the
active
pharmaceutically active agent is a restricted pharmaceutically active agent.
Optionally
or additionally, the active pharmaceutically active agent is selected from the
group
comprising: tetrahydrocannabinol (THC), salvinorin A, benzoylmethylecgonine,
dimethyltryptamine, psilocybin. Optionally or additionally, the substance is
organized
with a pre-determined amount of the active pharmaceutically active agent per
unit area
of the each cartridge in the tape, the daisy or the magazine. Optionally or
additionally, a
thickness of the cartridge ranges from about 0.2 mm to about 2.0 mm.
Optionally or
additionally, the tape, the daisy or the magazine comprises about 5 grams to
about 100
grams of the substance. Optionally or additionally, the tape, the daisy or the
magazine
comprises a sufficient amount of the active pharmaceutically active agent for
at least
two treatments. Optionally or additionally, the cartridge comprises a first
material layer
coupled to the substance, the first layer comprising apertures large enough to
let gas
escape but small enough to contain residue of the heated substance. Optionally
or
additionally, a diameter of the apertures ranges from 25 tm ¨ 500 p.m.
Optionally or
additionally, the cartridge comprises a second material layer coupled to the
substance,
the second layer adapted to transmit heat to the substance without
substantially
distributing the heat across the second layer. Optionally or additionally, the
heating
element and the substance are held between the first and the second layers .
In an embodiment of the invention, the device further comprises an inhaler
unit,
the inhaler unit comprising a mouthpiece for inhalation of the
pharmaceutically active
agent, the mouthpiece forming fluid communication with a vapor chamber of the
device, the vapor chamber comprising the vaporized active pharmaceutically
active
agent.
Optionally, the mouthpiece comprises a one-way valve to control fluid flow
away from the vapor chamber. Optionally or additionally, the device further
comprising
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a sensor in fluid communication with the mouthpiece, the sensor adapted to
estimate an
air flow rate and send a signal to a controller, the controller adapted for
vaporizing the
pharmaceutically active agent according to the airflow rate.
In an embodiment of the invention, the device further comprises a controller
configured to synchronize the application of heat with the movement of a
cartridge
and/or with airflow rate effected by inhalation.
In an embodiment of the invention, the device further comprises circuitry for
controlling (controller) activation of the heating element.
In an embodiment of the invention, the device further comprises a
communication interface for communicating to one or more external computers
and/or
systems and/or patient/physician interfaces.
In an embodiment of the invention, the device further comprises a dose display
meter for providing visual output of the vaporization of the pharmaceutically
active
agent.
In an embodiment of the invention, the device is portable and weights no more
than 300 grams.
In an embodiment of the invention, the device further comprises a memory
adapted to hold at least one of prescription data and usage data, the memory
coupled to
the controller, the controller adapted to control at least one of the heating
element and
the mechanism according to the dose and/or regimen data.
In an embodiment of the invention, the device further comprises a unique ID
adapted for tracking the device use by an associated patient.
In an embodiment of the invention, the device further comprises a sensor
adapted to detect a physical breach of the device.
There is provided in accordance with an embodiment of the invention, a method
for controlled vaporization of an active pharmaceutically active agent from a
substance,
the substance is organized as a cartridge, the method comprising;
applying heat to an area of the cartridge to vaporize a predetermined amount
of
the active pharmaceutically active agent and; moving the cartridge relative to
a heat
source.
Alternatively, the heating element is comprised within the cartridge, and the
cartridge is moved relative to electrical contacts for powering the heating
element.
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In an embodiment of the invention, the method further comprises adjusting at
least one of timing and speed of the moving to vaporize the active
pharmaceutically
active agent according to a delivery profile. Optionally, the substance
comprises a
macroscopic plant structure.
5 In an
embodiment of the invention, the vaporizing comprises vaporizing during
pulmonary delivery.
In an embodiment of the invention, the applying heat comprises applying heat
to
reach a target temperature in less than 500 milliseconds after a start signal.
There is provided in accordance with an embodiment of the invention, a method
10 for
controlled vaporization of at least one active pharmaceutically active agent
from at
least one type of substance by application of heat, the method comprising:
heating up multiple areas of substance organized as one or more cartridges
with
one user trigger, to release the at least one active pharmaceutically active
agent.
Optionally, the areas comprise different active pharmaceutically active
agents.
15 There
is provided in accordance with an embodiment of the invention, a
cartridge for therapeutic drug delivery comprising substance comprising an
active
pharmaceutically active agent, said substance organized with a predetermined
amount
of the active pharmaceutically active agent per unit area of said tape
(cartridge), and a
heating element comprised therein.
20 In an
embodiment of the invention, a plurality of cartridges is organized as a roll
of tape, a daisy or a magazine.
Illustrative Application:
According to some embodiments and aspects of the present disclosure, each and
any method, device, interface, system or sub-system presented herein can be
used for
25
treating a medical condition treatable by a pharmacologically active agent,
which is
vaporizable from a solid substance. In some embodiments of the present
disclosure, the
substance is a plant material.
Some plants which can be used in the context of the present disclosure,
include,
without limitation, Cannabis sativa, Cannabis indica, Cannabis ruderalis,
Acacia spp,
30 Amanita muscaria, Yage, Atropa belladonna, Areca catechu, Brugmansia spp.,
Brunfelsia latifolia, Desmanthus illinoensis, Banisteriopsis caapi,
Trichocereus spp.,
Theobroma cacao, Capsicum spp., Cestrum spp., Erythroxylum coca, Solenostemon
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scutellarioides, Arundo donax, Coffea arabica, Datura spp., Desfontainia spp.,
Diplopterys cabrerana, Ephedra sinica, Claviceps purpurea, Paullinia cupana,
Argyreia
nervosa, Hyoscyamus niger, Tabernanthe iboga, Lagochilus inebriens, Justicia
pectoralis, Sceletium tortuosum, Piper methysticum, Catha edulis, Mitragyna
speciosa,
Leonotis leonurus, Nymphaea spp., Nelumbo spp., Sophora secundiflora, Mucuna
pruriens, Mandragora officinarum, Mimosa tenuiflora, Ipomoea violacea,
Psilocybe
spp., Panaeolus spp., Myristica fragrans, Turbina corymbosa, Pas siflora
incarnata,
Lophophora williamsii, Phalaris spp., Duboisia hopwoodii, Papaver somniferum,
Psychotria viridis, spp., Salvia divinorum, Combretum quadrangulare,
Trichocereus
pachanoi, Heimia salicifolia, Stipa robusta, Solandra spp., Hypericum
perforatum,
Peganum harmala, Tabernaemontanaspp., Camellia sinensis, Nicotiana tabacum,
rusticum, Virola theidora, Voacanga africana, Lactuca virosa, Artemisia
absinthium,
Ilex paraguariensis, Anadenanthera spp., Corynanthe yohimbe, Calea
zacatechichi,
Coffea spp. (Rubiaceae), a Sapindaceae, Camellia spp., Malvaceae spp.,
Aquifoliaceae
spp., Hoodia, spp. Chamomilla recutita, Passiflora incarnate, Camellia
sinensis, Mentha
piperita, Mentha spicata, Rubus idaeus, Eucalyptus globulus, Lavandula
officinalis,
Thymus vulgaris, Melissa officinalis, any part and any combination thereof.
Other plants and plant materials, which can be used beneficially to vaporize
at
least one pharmaceutically active agent in the context of embodiments of the
present
disclosure include, without limitation, Aloe Vera, Angelica, Anise, Ayahuasca
(Banisteriopsis caapi), Barberry, Black Horehound, Blue Lotus, Burdock,
Camomille/Chamomile, Caraway, Cat's Claw, Clove, Comfrey, Corn Silk, Couch
Grass, Damiana, Damiana, Dandelion, Ephedra, Eucalyptus, Evening Primrose,
Fennel,
Feverfew, Fringe Tree, Garlic, Ginger, Ginkgo, Ginseng, Goldenrod, Goldenseal,
Gotu
Kola, Green Tea, Guarana, Hawthorn, Hops, Horsetail, Hyssop, Kola Nut, Kratom,
Lavender, Lemon Balm, Licorice, Lion's Tail (Wild Dagga), Maca Root,
Marshmallow,
Meadowsweet, Milk Thistle, Motherwort, Passion Flower, Passionflower,
Peppermint,
Prickly Poppy, Purslane, Raspberry Leaf, Red Poppy, Sage, Saw Palmetto, Sida
Cordifolia, Sinicuichi (Mayan Sun Opener), Spearmint, Sweet Flag, Syrian Rue
(Peganum harmala), Thyme, Turmeric, Valerian, Wild Yam, Wormwood, Yarrow,
Yerba Mate, Yohimbe, and any part and any combination thereof.
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In some embodiments, the active agent is a terpenoid, alkaloid or cannabinoid.
For example, in some embodiments, the active agent is a diterpenoid such as,
but not
limited to salvinorin A from salvia. In other embodiments, the active agent is
an
alkaloid such as, but not limited to, benzoylmethylecgonine from the coca
plant, or the
active agent is a tryptamine such as psilocybin from mushrooms. In alternative
embodiments the active substance is dimethyltryptamine (DMT) from a variety of
plants. In further embodiments, the active substance is nicotine from tobacco.
In
further embodiments, the active substance is a terpenoid, e.g., limonene, a-
pinene, f3-
myrcene, linalool, f3-caryophyllene, caryophyllene, nerolidol or phytol,
present in
various plant forms.
According to some embodiments, the plant material is selected from the group
consisting of Cannabis sativa, Cannabis indica, and Cannabis ruderalis, and
according to
some embodiments, the plant is Cannabis sativa.
Cannabis is a natural source for vaporizable cannabinoids, which constitute a
class of diverse chemical compounds that act on cannabinoid receptors found in
cells of
humans and other animals. Cannabinoids, which include endocannabinoids
(produced
in animals), phytocannabinoids (found in cannabis and some other plants) and
synthetic
cannabinoids (manufactured chemically), are known to bind to naturally
receptor
proteins, and repress neurotransmitter release in the brain. The primary
psychoactive
compound of cannabis, is the phytocannabinoid A9-tetrahydrocannabinol (THC).
Cannabidiol (CBD) is another major constituent of the plant, representing up
to
40 % in extracts of the plant resin. There are at least 85 different
cannabinoids isolated
from cannabis, exhibiting varied effects, which include cannabigerols (CBG),
cannabichromenes (CBC), cannabinol (CBN), cannabinodiol (CBDL), cannabicyclol
(CBL), cannabielsoin (CBE), cannabitriol (CBT), Cannabidivarin (CBDV),
Tetrahydrocannabivarin (THCV) and other miscellaneous types.
Tetrahydrocannabinol (Delta-9-tetrahydrocannabinol; A9-THC; THC) is the
primary psychoactive component of the Cannabis plant. A9-THC and A8-THC mimic
the action of anandamide, a neurotransmitter produced naturally in mammals.
These
two THC's produce the psychoactive effects associated with cannabis by binding
to the
CB1 and CB2 cannabinoid receptors in the brain; it has been reported to
exhibit
approximately equal affinity for the CB1 and CB2 receptors. THC appears to
ease
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moderate pain (analgesic) and to be neuroprotective, while studies also show
that THC
reduces neuroinflammation and stimulates neurogenesis.
Cannabidiol (CBD) is not considered to be psychoactive, and was thought not to
affect the psychoactivity of THC. However, recent evidence shows that smokers
of
cannabis with a higher CBD/THC ratio were less likely to experience
schizophrenia-like
symptoms. This is supported by psychological tests, in which participants
experience
less intense psychotic-like effects when intravenous THC was co-administered
with
CBD.
Cannabidiol has a different affinity for CB1 and CB2 receptors compared to
THC (CBD has a greater affinity for the CB2 receptor than for the CB1
receptor), but
acts as an indirect antagonist of cannabinoid agonists. Recently it was found
to be an
antagonist at the putative new cannabinoid receptor, GPR55, a GPCR expressed
in the
caudate nucleus and putamen. Cannabidiol has also been shown to act as a 5-
HT1A
receptor agonist, an action that is involved in its antidepressant,
anxiolytic, and
neuroprotective effects. CBD is also reported to relieve convulsion,
inflammation,
anxiety, and nausea.
CBD is known to play a role in preventing the short-term memory loss
associated with THC in mammals. CBD has been suggested as a therapeutic agent
in
the treatment of schizophrenia. Researchers discovered CBD's ability to "turn
off" the
activity of ID1, the gene responsible for metastasis in breast and other types
of cancers,
including the particularly aggressive triple negative breast cancer.
Hence, accordion to some embodiments of the present disclosure, the
pharmacologically active agent is a cannabinoid selected from the group
consisting of
A9-tetrahydrocannabinol (THC), cannabidiol (CBD), cannabigerols (CB G),
cannabichromenes (CBC), cannabinol (CBN), cannabinodiol (CBDL), cannabicyclol
(CB L), cannabielsoin (CBE), Cannabidivarin (CBDV), Tetrahydrocannabivarin
(THCV) and cannabitriol (CBT), and according to some embodiments, the
pharmacologically active agent is selected from the group consisting of A9-
tetrahydrocannabinol (THC) and cannabidiol (CBD).
In some embodiments, the pulmonary delivery method described herein utilizes
THC or, more specifically, A9-THC as the pharmaceutically active agent. In
some
embodiments, the THC dose (pre-determined vaporized amount) is about 0.1-2 mg,
0.2-
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2 mg, 0.1-4 mg, 0.1-5 mg, 0.1- 8 mg, 0.1-10 mg which has been shown to be
salutary
analgesics for a heterogeneous variety of neuropathic pain conditions. Such
low THC
dose can be vaporized accurately and consistently from natural cannabis in an
amount
that ranges from 5 to 50 mg, 7 to 35 mg, 10 to 30 mg, 12 to 20 mg, depending
on the
total amount of A9-THC available in the cannabis. In some preferred
embodiments, the
cannabis contains about 20 % A9-THC, and the amount of cannabis used in the
inhaler
for each dose ranges from 10.0 to 20.0 mg.
Thus, in some embodiments, a high resolution in determining and controlling
the
amount of a pharmaceutically active agent is provided by the pulmonary
delivering
method described herein. In some embodiments, individual pre-selected
vaporized
amounts (doses) of, e.g., THC, are released electronically (by heating a pre-
weighed
portion of cannabis), in amount increments of 0.1 mg, ranging from 0.1 to 6.0
mg, 0.3 to
1.7 mg, 0.1 to 2.0 mg, from 0.2 to 1.8 mg, from 0.5 to 2.0 mg, from 0.5 1.5
mg,
including any subranges and any intermediate values therebetween.
In accordance with embodiments of the method provided herein, predictive
PK/PD protocols are developed for vaporized cannabinoids, based on clinical
data,
accumulated individually for each patient as well on a cohort of patients,
which account
for the dose and regimen administered, based on individual and population
parameters,
as described hereinabove. These protocols accurately simulate the PK profile
of a
patient after delivering a pre-determined dose, or pre-determined regimen, and
in
parallel predict the PD profile which is composed of symptom relief
(therapeutic effect)
and psychoactive levels (adverse effect). Once a sub therapeutic level, and
the adverse
psychoactive level are correlated with PK and patient parameters, a relatively
narrow
therapeutic window is derived, in which the MDI device can precisely maintain
in the
patient, by automating specific pre-selected vaporized amounts (doses and/or
regimen).
By inputting patient data, the protocol calculates the recommended dose and
regimen for that specific patient in order to stay within the therapeutic
window for a
specific duration.
According to these embodiments, the device selectively administers different
doses at different time intervals so as to prevent adverse effects while still
alleviating
symptoms.
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A system for pulmonary delivery:
As discussed hereinabove, the method and device presented herein are highly
suitable for personalization, self-titration, mechanization and automatization
of an
otherwise complex and challenging mode of administration and treatment of a
variety of
5 medical conditions; while any personalized treatment protocol presents
challenges, a
treatment based on pulmonary delivery of active agents vaporized by heat from
natural
substances is a task which has not been achieved hitherto.
Once the problem of accuracy, consistency and reproducibility is solved by
using a the MDI device disclosed herein; and once the need for calibrating and
10 presetting the device to stay within a desired therapeutic window, based
on widely
accepted PK/PD experimental parameters has been served, as disclosed herein,
the
present inventors have conceived an integrated system that can control the
device using
input collected from a variety of sources so as to provide a highly
personalized and
effective treatment for any given patient, also in real-time.
15
According to an aspect of some embodiments of the disclosure, there is
provided
a system that includes:
a metered dose inhaler device for pulmonary delivering to a subject at least
one
pre-determined vaporized amount of at least one pharmacologically active agent
being
in a plant material by controllably heating the plant material so as to
vaporize a pre-
20 .. determined vaporized amount of the agent from the plant; and
a controller associated with the inhaler device, and configured to control the
pre-
determined vaporized amount.
According to an aspect of some embodiments of the disclosure, there is
provided
a system of pulmonary delivering to a subject at least one pharmacologically
active
25 agent being in a plant material; the system includes:
a metered dose inhaler device configured to vaporize at least one pre-
determined
vaporized amount of the agent upon controllably heating the plant material;
and
a controller configured to select the at least one pre-determined vaporized
amount of the agent so as to achieve at least one pre-determined
pharmacokinetic effect
30 and/or at least one pre-determined pharmacodynamic effect induced by the
agent in the
subject.
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According to an aspect of some embodiments of the disclosure, there is
provided
a system for pulmonary delivering to a subject at least a first
pharmacologically active
agent and a second pharmacologically active agent, at least one of which being
in at
least one plant material; the system includes:
a metered dose inhaler device configured independently deliver the agents to
the
subject by heating the at least one plant material to vaporize at least a
first pre-
determined vaporized amount of the first agent and at least a second pre-
determined
vaporized amount of the second agent; and
a controller configured to effect the heating of the first pre-determined
vaporized
successively, concomitantly and/or at least partially overlapping with the
second pre-
determined vaporized amount,
wherein each of the pre-determined vaporized amounts of each of the agents is
selected to induce in the subject independently at least one pharmacokinetic
effect
and/or at least one pharmacodynamic effect.
According to an aspect of some embodiments of the disclosure, there is
provided
a system that includes:
a metered dose inhaler device for pulmonary delivering to a subject at least
one
pre-determined vaporized amount of at least one pharmacologically active agent
being
in a plant material by controllably heating the plant material so as to
vaporize a pre-
determined vaporized amount of the agent from the plant; and
a controller associated with the inhaler device, and configured to control the
pre-
determined vaporized amount,
wherein the controller is configured to receive operation setting data
pertaining
to the pre-determined vaporized amount from a remote control device. In some
embodiments, the remote control device is configured to receive data
indicative of at
least one pharmacodynamic effect induced by the agent in the subject, and
further
configured to determine and transmit operation setting data pertaining to the
pre-
determined vaporized amount.
According to an aspect of some embodiments of the disclosure, there is
provided
a system that includes:
a metered dose inhaler device for pulmonary delivering to a subject at least
one
pre-determined vaporized amount of at least one pharmacologically active agent
being
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in a plant material by controllably heating the plant material so as to
vaporize a pre-
determined vaporized amount of the agent from the plant; and
a controller associated with the inhaler device, and configured to control the
pre-
determined vaporized amount based on data indicative of at least one
pharmacodynamic
effect induced by the agent in the subject.
According to an aspect of some embodiments of the invention, there is provided
a system that includes a metered dose inhaler device for pulmonary delivering
at least
one pre-determined amount of at least one pharmacologically active agent to a
subject.
The system further includes at least one sensor for monitoring at least one
pharmacodynamic effect in the subject induced by the agent, e.g. a
psychoactive effect;
and a processing unit associated with the inhaler device and with said at
least one
sensor. In some embodiments, the processing unit is configured to determine
the pre-
determined amount based on the data received from the sensor. The amount,
which is
being determined and controlled, may be a single dose or a regimen.
The indicative data is obtainable from a variety of sources, such as
statistical
data of a pharmacodynamic effect induced by the agent in a population, a user
history,
preferences and habits, a physician prescription and the like. In some
embodiments, the
indicative data is obtainable via at least one sensor configured for
monitoring
pharmacodynamic effects in a subject and/or via a user interface device
configured for
inputting data obtainable from such as sensors. In some embodiments, the
controller is
configured to receive indicative data pertaining to a pharmacodynamic effect
from a
sensor and/or a user interface device.
According to some embodiments, the controller is in direct and/or indirect
communication with a sensor and/or an interface device, namely the controller
can be
associated via direct communication with the source of the indicative data
(sensor
and/or interface device), or be associated therewith via a remote control
device.
According to some embodiments, the system includes an inhaler device as
described hereinabove, a controller as described hereinabove, and at least one
sensor
and/or a user interface as described hereinabove, each configured
independently to
provide to the controller data indicative of at least one PD effect induced by
the active
agent in the subject.
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According to an aspect of some embodiments of the disclosure, there is
provided
a system that includes, without limitation:
a metered dose inhaler device for pulmonary delivering to a subject at least
one
pre-determined vaporized amount of at least one pharmacologically active agent
being
in a plant material by controllably heating the plant material so as to
vaporize a pre-
determined vaporized amount of the agent from the plant;
at least one sensor for monitoring at least one pharmacodynamic effect in the
subject induced by the agent and/or a user interface device for inputting data
obtained
from at least one sensor for monitoring at least one pharmacodynamic effect in
the
subject induced by the agent; and
a controller associated with the inhaler device and with the at least one
sensor.
In some embodiments, the controller used in the system described herein is
configured to control the pre-determined vaporized amount by controlling the
heating of
the substance (e.g., plant material). Controllably heating the plant material
is effected,
for example, by controlling at least one of a heating temperature, a heating
pattern
(which part of the plant material to heat), a heating rate (how many times the
plant
material is exposed to heat), a heating duration (how long the plant material
is exposed
to heat in any given heating event), and any combination thereof.
In some embodiments, the controller is configured to control the pre-
determined
vaporized amount by controlling the airflow in the inhaler device, for example
by
controlling duct opening, valves and shutters in the inhaler device.
In some embodiments, the controller is configured to control the pre-
determined
vaporized amount by controlling the timing of one or more inhalation events.
For
example, the pre-determined vaporized amount is delivered in more than one
inhalation
event, and the controller is configured to generate at least one alert signal
to the subject
to use the inhaler device at indicated time points, at indicated time
intervals and any
other schedule so as to complete the pulmonary delivery of the pre-determined
vaporized amount to the subject.
In some embodiments, by controlling the abovementioned heating and airflow
parameters in the inhaler device, the controller is used to adjust the pre-
determined
vaporized amount so as to achieve a pre-determined pharmacokinetic effect
and/or a
pre-determined pharmacodynamic effect based on the pharmacodynamic effect. In
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some embodiments, the controller is configured for effecting the adjustment of
the pre-
determined vaporized amount in real-time.
In general, the controller is used to carry out more complex treatment plans,
such as a regimen, a delivery of more than one active agent, each having a
different
dose and/or regimen, and/or other dose and timing related adjustments. In some
embodiments, a controller can be configured for adjusting the regimen so as to
achieve
a pre-determined pharmacokinetic effect and/or a pre-determined
pharmacodynamic
effect based on the pharmacodynamic effect. In some embodiments, the
controller is
configured for effecting a pre-defined regimen that comprises delivering at
least two
pre-determined vaporized amounts. In some embodiments, the controller is
configured
for real-time adjustment of various operational settings of the inhaler device
and
parameters of the pulmonary delivery.
According to some embodiments, the system further includes or may be in
communication with a user interface device, which can be used to input
information and
data into the controller, and/or to display, transmit or otherwise output data
and
information from the controller. In some embodiments, the user interface
comprises an
output device for providing information to at least one of the following: the
subject, a
practitioner, a memory unit and a remote device (a server, a display, a remote
monitoring system/device and the like). In some embodiments, the user
interface device
includes a smartphone device. A smartphone may include a touchscreen, a
microphone,
a speaker, a GPS receiver, an accelerometer, a thermometer, a light detector
and the
like.
In some embodiments, the controller is configured for monitoring at least one
of
the at least one pre-determined pharmacokinetic effect and/or the at least one
pre-
determined pharmacodynamic effect, based on data received via the user
interface
device. Accordingly, the controller is configured for adjusting the pre-
determined
vaporized amount in real-time.
An aspect of some embodiments relates to treating a subject with a low dose of
inhaled THC. In some embodiments, the low dose comprises between 0.2-2 mg of
THC.
In some embodiments, the low dose is between 0.3 mg and 1.5 mg THC, between
0.5-1
mg THC, between 0.6 and 1.5 mg THC, between 0.75-1 mg THC, between 0.2 -0.75,
between 0.2 -0.5 mg THC, and/or other sub ranges. In some embodiments, an
actual
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amount of THC selected from the range of 0.2-2 mg THC is sufficient to reduce
one or
more treated symptoms (such as pain and/or nausea) without return of the
symptom(s)
to a pre-inhalation degree for a time period of at least one hour, at least 90
minutes, at
least two hours, at least three hours, at least five hours, or intermediate or
longer time
5
periods. Optionally, the following low dose is delivered after at least two
hours, after 90
minutes, after 110 minutes, after 130 minutes, after 150 minutes or
intermediate, longer
or shorter time periods. Alternatively, two consecutive low doses are
delivered after at
least four hours. Optionally, the low dose is delivered through a plurality of
delivery
events of even lower doses during a certain time period (for example, a
plurality of
10
delivery events during a 2 hour time period, with a dose of 0.5 mg THC
delivered in
each event). Optionally, the total amount delivered in the two hour time
period is no
more than a preset low dose. Optionally, the total dose is set at 1 mg or 1.5
mg/2 hours,
such that the total inhaled amount during any such time period in the
aforesaid example
does not exceed the total dose.
15 In some
embodiments, a period of time between successive delivery events is
selected to be sufficient for the effect of THC to take place. Optionally, the
time period
is determined by the user. Alternatively, the time period is predetermined by
a medical
practitioner. In some embodiments, the device is configured to restrict
delivery so that a
time period of at least 10 minutes, at least 20 minutes, at least 30 minutes
or
20
intermediate, longer or shorter time periods exist between successive delivery
events. In
some embodiments, once a maximal low dose (e.g. 0.2-2 mg THC) is reached
and/or
when the already inhaled dose is shown to be sufficient to alleviate
symptom(s) and/or
an undesired effect has reached a maximal tolerated level (as sensed by the
user),
delivery of the next dose may be postponed to a later time. In some
embodiments, a
25 time
period between successive delivery events is proportional to the amount of THC
inhaled in the successive delivery events.
In some embodiments, the device automatically locks to prevent additional
delivery, for example when a maximal dose per time period and/or a maximal low
dose
is reached. In an example in which the maximal dose is limited to a total of 1
mg THC
30 in a
four hour time period, 0.5 mg THC may be delivered at a first delivery event,
the
device may lock for two hours and then enable another delivery of 0.5 mg THC.
Alternatively, after two delivery events of 0.5 mg THC each (with any time
interval in
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between them), the device may lock for 4 hours. In some embodiments, a
duration of
the lock-out period is determined according to one or more parameters such as
the type
of source material used (e.g. a cannabis strain), the type of active-
substance(s)
delivered, usage data of the patient, prescription data, safety
considerations, and/or
others.
In some embodiments, the device is configured to deliver a plurality of low
doses in a plurality of delivery events (optionally, each dose is lower than a
maximal
low dose) with a time interval between delivery events being sufficient for
the user to
estimate the effect of the THC that was delivered. Optionally, delivery is
stopped when
the maximal low dose is reached and/or when a sensed effect dictates a stop.
In some
embodiments, after this time point, no THC is delivered for at least 2 hours,
4 hours, 6
hours or intermediate, longer or shorter time periods. Optionally, the time
period is
proportionate to the total amount of THC delivered earlier. Optionally, the
time period
is measured relative to the first delivery event and/or relative to the time
point in which
the maximal dose was reached and/or relative to the last delivery event, after
which
sufficient time has passed to sense the effect of THC but no additional THC
was
delivered.
In some embodiments, one or more maximal amounts of active substance are
allocated for predefined time periods, for example 0.5 mg for 2 hours, 0.6 mg
for two
hours, 0.75 mg for two hours, 1.5 mg for 3.5 hours, 3.5 mg for 10 hours. In
some
embodiments, two or more such maximal amounts and periods are allocated
simultaneously (e.g. no more than 0.2 mg for 2 hours and no more than 0.5 mg
for 6
hours). In some embodiments, the device operates according to a "budgetary"
delivery
profile in which an amount given at a certain time point is selected so that
additional
delivery can be provided within the predefined time period, without exceeding
the
maximal amount. Optionally, the amount is reduced at each successive delivery.
Additionally or alternatively, the device allows "free" delivery per demand of
the
patient until the maximal amount defined per the time period is reached.
In some embodiments, upon an attempt of the patient to use the device (e.g.
detection of inhalation and/or when the patient turns the device on or
otherwise actuates
the device) an amount to be provided is automatically calculated based on
previous
deliveries performed within a selected time period. If no amount may be
provided at a
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given attempt, the device may either communicate this to the patient (e.g. via
visible
and/or audible signals) or provide an alternative active substance or even a
placebo.
In some embodiments, the dose is low enough so that the intensity of the
psychoactive effects of THC are not statistically significant compared to
placebo, while
a therapeutic effect of THC remains sufficient to alleviate symptoms. In some
embodiments, the dose is low enough so that psychoactive effects of THC are
mild
and/or reversible and/or recede rapidly, while a therapeutic effect of THC
remains
sufficient to alleviate symptoms.
In some embodiments, a total of no more than 0.7 mg, no more than 1 mg, no
more than 2.5 mg, no more than 3 mg, no more than 3.5 mg THC, no more than 5
mg,
no more than 7.5 mg THC, no more than 8 mg THC, no more than 6 mg THC, no more
than 10 mg THC or intermediate, larger or smaller amounts are delivered over a
time
period of 24 hours. In some embodiments, the maximal amount is delivered
during the
24 hour time period in a plurality of delivery events, each providing no more
than 2 mg
THC, no more than 0.7 mg THC, no more than 0.5 mg THC, no more than 0.2 mg THC
or no more than 0.1 mg THC. In some embodiments, over a 24 hour time period,
no
more than 8 delivery events, no more than 6 delivery events, no more than 5
delivery
events, no more than 3 delivery events, no more than 1 delivery event, no more
than 10
delivery events or intermediate, larger or smaller number of delivery events
are
provided, wherein in each delivery event a low dose of between 0.2-2mg THC is
delivered to the patient through inhalation. Optionally, additional delivery
events take
place but only very small, insignificant amounts of THC are delivered (for
example less
than 0.2 mg THC, less than 0.1 mg THC per delivery event).
An aspect of some embodiments relates to an inhaler configured for delivering
one or more low doses of THC, each dose comprising no more than 2 mg THC, no
more
than 1 mg THC, no more than 0.75 mg THC, no more than 0.6 mg THC, no more than
0.5 mg THC, no more than 0.2 mg THC or intermediate, larger or smaller amounts
of
THC. Optionally, the THC is extracted by vaporizing (optionally without
burning) a
THC-comprising material.
As used herein, a THC-comprising material may mean material comprising THC
or THC acid (THCA), which converts to THC upon vaporization. Thus, when THC-
comprising material is said herein to comprise THC, this should be taken to
mean that it
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comprises THC and/or THCA. THC-comprising material may comprise or consist of
plant material, with or without added substances, including without limitation
comprising synthetic and/or extracted THC and/or one or more other
cannabinoids.
Optionally the THC-comprising material comprises or consists of an inert
carrier
comprising synthetic and/or extracted THC. In some embodiments, an inert
carrier is a
carrier that does not react with THC and does not provide vapor in storing and
operation
conditions up to the end of delivery of THC to a user.
In some embodiments, the inhaler device is configured to control the amount of
THC delivered to a subject by at least one of selecting one or more cartridges
from a
plurality of cartridges, each having a different amount of THC content, and/or
controlling one or more parameters of THC extraction, including for example a
heating
profile applied to THC-comprising material and/or a pattern of airflow to the
user
and/or through the THC-comprising material.
In some embodiments, the inhaler is configured to limit the amount of THC
extracted and/or the amount of THC delivered to a subject, for example using a
controller configured to adjust one or more of: heating parameters of the THC-
comprising material; the amount of THC-comprising material heated; regulation
of
airflow to the subject and/or airflow through the THC-comprising material. In
some
embodiments, the inhaler device is configured to limit the amount of THC by
comprising one or more cartridges each packed with THC-comprising material at
an
amount in which the THC content is about two fold the amount of THC being
extracted.
Alternatively, the amount of THC in the THC-comprising material is about three
times
the amount of THC being extracted, about four times the amount being
extracted, about
6 times the amount being extracted or intermediate, larger or smaller amounts.
Optionally, the THC content of the material is selected in accordance with an
extraction
efficiency of the inhaler, for example in an inhaler with 60% extraction
efficiency, to
extract 2 mg THC, a THC content of the material being heated would be about
3.33 mg.
In some embodiments, the inhaler comprises only one cartridge comprising
material for
a single dose only. Optionally, the inhaler is configured re-heat the same
cartridge until
all THC is extracted. Optionally, the cartridge is manually replaced by a
user.
In some embodiments, a low dose of THC refers to a dose exiting the inhaler.
In
some embodiments, a low dose exiting the inhaler is equivalent to the dose
entering the
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user's mouth and/or entering the user's respiratory tract. In some
embodiments, at least
80%, at least 90% at least 95%, at least 99% or intermediate, higher lower
percentages
of the amount of THC exiting the inhaler (for example through the mouthpiece)
is
inhaled by the user.
In some embodiments, the specific low dose delivered (e.g. an amount between
0.2-2 mg THC) is selected so as to have one or more pharmacological effects on
the
user, for example reduce nausea, reduce a level of pain, increase appetite,
reduce fatigue
and/or other effects. Optionally, the specific low dose is selected in
accordance with a
sub-indication of the user, for example 0.5 mg THC is prescribed for treating
a low
level of nausea, 1 mg THC is prescribed for treating an intermediate level of
nausea, 1.5
mg THC is prescribed for treating a high level of nausea; for example 0.3 mg
THC is
prescribed for treating mild pain, 0.7 mg THC is prescribed for treating
intermediate
pain, 1.7 mg THC is prescribed for treating a pulsating pain, and/or lower,
intermediate,
or higher doses selected according to a user indication or a sub-indication
thereof.
In some embodiments, the inhaler is configured to deliver one or more other
pharmacologically active substances sequentially or concomitantly with the
THC.
An aspect of some embodiments relates to a system configured to deliver THC
to a user. In some embodiments, the system may consist of one or more devices
and/or
systems and comprise a memory, a decision module, and an inhaler suitable for
delivering the THC to the user. In some embodiments, the memory stores one or
more
scheduled regimens for delivery of THC to the user, each scheduled regimen
defining
one or more of: a maximal amount of THC to be delivered; a time period within
which
the maximal amount can be delivered; minimal and/or maximal time intervals
between
successive deliveries; compositions and/or amounts of other active substances
(e.g.
cannabinoids) and/or placebos delivered to the user; and/or other regimen
related
parameters. In some embodiments, the decision module is configured to read
and/or
receive the scheduled regimens from the memory and to make a decision whether
delivery should take place. Optionally, the decision module is configured to
make such
decision at any given time point. In some embodiments, the inhaler reads
and/or
receives as input the decision made by the decision module, and delivery is
performed
accordingly. Optionally, a controller of the inhaler carries out delivery by
controlling
one or more of: heating of the THC-comprising material, airflow through the
inhaler,
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powering and/or electrical coupling of certain components of the inhaler (e.g.
electrodes
of the heating element); and/or other.
In some embodiments, the memory and/or decision module are included in the
inhaler device, for example as designated circuitry components of the
controller.
5
Additionally or alternatively, the memory and/or decision module are external
to the
inhaler, for example associated with a user interface device such as a
smartphone,
laptop, and/or any other personal device. Optionally, the memory, decision
module and
inhaler controller are configured to communicate with one another, for example
via
wireless communication.
10 In some
embodiments, the decision module comprises or is operably connected
to a timer and/or a clock, for determining delivery in accordance with the
scheduled
regimen. In some embodiments, the decision module starts a timer immediately
after a
delivery event. Optionally, the decision module places a lock on the delivery,
for
example for a predefined time period. Optionally, a decision is made in
advance (for
15 example
a decision to lock the inhaler for a predefined time period) and applied
locally.
In some cases, the decision module may decide to remove a lock before the
predefined
time period elapsed.
Certain features and/or functions of a "controller" for example as described
in
this application may be attributed to the memory and/or decision module as
well.
20 An
aspect of some embodiments relates to delivery of active substances at
predetermined ratios. Optionally, different ratios are delivered at different
times. In
some embodiments, a combination of THC and CBD at a predetermined THC:CBD
ratio is delivered in a dose. Optionally, a following dose comprises a
combination of
THC and CBD at a THC:CBD ratio which is at least 10% larger than the ratio of
the
25 first
dose. Alternatively, the second dose comprises a combination of THC and CBD at
a ratio which is at least 10% smaller than the ratio of the first dose. In
some
embodiments, the first dose is extracted from a cannabis strain having a first
predetermined THC:CBD ratio, and the second dose is extracted from a cannabis
strain
having a second predetermined THC:CBD ratio, different from the THC:CBD ratio
of
30 the
first strain. Optionally, a mixture of strains of used. Optionally, one or
more
extracted, purified and/or synthetic cannabinoids are used and/or added to a
dose of
cannabis, thereby to control or modify a proportion between the substances.
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An aspect of some embodiments relates to an inhaler comprising a total amount
of active substance (such as THC and/or other cannabinoid) sufficient for
treating a
patient only for a predefined time period such as a day, a week, a month, or
intermediate, longer or shorter time periods. In an example, the inhaler
comprises a total
of no more than 3 mg, 5 mg, 7 mg, 10 mg, 20 mg, 30 mg, or intermediate, larger
or
smaller amounts of THC for delivery over a week; in another example, the
inhaler
comprises no more than 10 mg, 50 mg, 100 mg, 200 mg or intermediate, larger or
smaller amounts of THC for delivery over a month. A potential advantage of an
inhaler
comprising a small amount of active substance which is sufficient only for
treating the
patient to alleviate symptoms may include reducing a likelihood of abuse, for
example
since the amount of restricted substance is so small that it is not sufficient
to bring one
to a high psychoactive state.
Figure 1 is a schematic diagram of a system comprising an MDI device (also
referred to herein as "inhaler device"), a physician interface and/or a
patient interface,
according to some embodiments of the invention.
In some embodiments, MDI device 901 is configured to communicate with a
physician interface 903 and/or with a patient interface 905. In some
embodiments, MDI
device 901 is configured to receive input from one or both of the interfaces
903 and/or
905. Additionally or alternatively, MDI device 901 is configured to send
output to one
or both of the interfaces 903 and/or 907.
In some embodiments, communication between the system components is
performed via one or more data transfer means such as a USB connection, a
cable
connection, a wireless connection, and/or any suitable wired and/or wireless
communication protocol.
In some embodiments, communication between the system components is
performed through one or more communication modules, such as communication
module 907 of MDI device 901, communication module 909 of physician interface
903,
and/or communication module 911 of patient interface 905.
In some embodiments, MDI device 901 comprises a controller 913, configured,
for example, to activate heating of the substance to thereby vaporize the
active agent,
control the heating profile and/or activation of heat, control a cartridge
feed mechanism
of the MDI device, read data from a memory 919 of MDI device 901, control
power
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usage, and/or other functions. In some embodiments, controller 913
communicates with
a memory 919. Optionally, memory 919 is configured to store prescription data,
personal usage data, patient details, personal PD effects obtained from the
patient, dose
and/or regimen modifications, parameters obtained from the patient in response
to a
change in a dose and/or regimen, and/or other values or information. In some
embodiments, controller 913 activates pulmonary delivery of the active agent
according
to dose and/or regimen data stored in memory 919. In some embodiments, memory
919
is configured to store usage data and/or feedback data from the patient with
respect to a
specific dose and/or regimen and/or with respect to a pre-selected (desired)
PD profile
of the active agent in the patient.
In some embodiments, physician interface 903, comprising, for example, one or
more of a controller 915, a memory 921 and/or a communication module 909, is
configured on a personal computer (tablet computer, laptop computer, desktop
computer, or others), a mobile device such as a smartphone, a handheld device,
a
wearable device, a wrist device or an integrated eyewear device, a clinic or
hospital
monitor and/or any other suitable device. Optionally, the physician is
provided with
remote access to MDI device 901. Additionally or alternatively, physician
activates
MDI device 901 directly. In some embodiments, the physician pre-programs (pre-
calibrates or presets) MDI device 901 with a pre-determined vaporized amount
(dose
and/or regimen) suitable for an individual patient. In some embodiments, data
is sent
from physician interface 903 to patient interface 905, for example for
instructing the
patient or for effecting preset adjustments.
In some embodiments, patient interface 905, comprising, for example, one or
more of a controller 917, a memory 923 and/or a communication module 911, is
configured on a personal computer (tablet computer, laptop computer, desktop
computer, or others), a mobile device such as a smartphone, and/or on MDI
device 901
itself.
In some embodiments, patient interface 905 receives an input 929. The input
may be received from one or more of the patient, the physician interface, the
database
server, the MDI device. Examples of various types of inputs may include a dose
and/or
regimen defined by the physician and received on the physician interface, a
current
personal PD effect of the patient, inserted by the patient and/or obtained
from the
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patient, personal usage statistics recorded for example on the database server
and/or on
the memory of the MDI device, an indication of inhalation duration and/or
inhalation
volume sensed by the MDI device, and/or other types of input.
In some embodiments, patient interface 905 comprises a display 927.
Optionally, the display is an interactive display, for example a touch screen
of a
smartphone, a handheld device, a wearable device, a wrist device or an
integrated
eyewear device.
In some cases, certain functions such as transferring data to the physician,
accessing the database to acquire information such as user/patient
instructions, and/or
other functions are enabled by patient interface 905, while other function
such as
modifying the pre-determined vaporized amount (dose) and/or regimen (plurality
of
doses), viewing protocols of other patients, and/or other functions are not
permitted by
patient interface 905. Optionally, the physician sets the patient interface
access
definitions per an individual patient.
In some embodiments, patient interface 905 and/or MDI device 901 are
configured to notify the patient every time a pulmonary delivery (an
inhalation) is due.
Optionally, the notice is provided automatically based on a scheduled regimen
stored in the memory. Additionally or alternatively, the notice is set by the
patient.
Additionally or alternatively, the notice is issued by the physician.
In some embodiments, one or more of the system components communicates
with a database server 925, by receiving input from the database and/or
sending out
information to the database. In some embodiments, the database comprises
individual
data of the patient, for example including medical history of the patient,
data transmitted
by MDI device 901, input data from the physician, input data from the patient,
and/or
other information. Optionally, the database server is configured to perform
calculations
on the data. In some embodiments, database server 925 comprises collective
data,
including, for example, one or more of clinical experiment results, results of
other
patients, research data, and/or other data.
Optionally, database server 925
communicates with a plurality of treatment systems being used by various
patients.
Data from various interactions between patients and the MDI device is
collected in the
central database, continuously learning individual usage patterns of patients
and
recommending dose and/or regimen accordingly. Utilizing the collective user
database
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may improve generating of accurate predictive dose and/or regimen for current
and new
patients, improving the overall therapeutic success rate of the treatment.
In some embodiments, according to personal feedback data obtained from the
patient using MDI device 901 and/or by patient interface 905, the pre-
determined
vaporized amount (dose and/or regimen) is automatically modified by controller
917 of
the patient interface and/or by controller 913 of the MDI device to compensate
for
inadequate settings or misuse of the MDI device, for example in a situation in
which the
patient does not use the MDI device when instructed to, and/or use the MDI
device is
carried out at a timing different than the preset regimen. One or more actions
may be
taken in response, for example postponing the next dose, increasing or
decreasing the
next dose (and/or following doses), and/or otherwise altering the regimen.
In some embodiments, a patient using MDI device 901 may wish to schedule
their dose and/or regimen in a way in which possible adverse effects least
interfere with
the patient's daily activities. While certain adverse effects are tolerable in
a home
setting or at certain time of day, and are an acceptable trade off for symptom
relief,
these adverse effects may be undesirable when the patient is engaged in
activities such
as driving, attending a meeting, and/or other activities. Optionally, using
patient
interface 905 and/or by directly activating MDI device 901, the patient
schedules a dose
and/or regimen in a manner that least interferes with their planned
activities.
Additionally or alternatively, MDI device 901 and/or patient interface 905 are
configured to actively impose a certain dose and/or regimen, for example based
on input
from the patient. In an example, the patient inserts their planned daily
activities and
timing of those activities, and the dose and/or regimen is automatically
modified
accordingly. Optionally, the dose and/or regimen is automatically modified to
ensure
that the patient is in a suitable condition to perform the planned activity,
for example
ensuring that during driving the level of an adverse effect is relatively low
or not
perceived.
In some embodiments, the patient may voluntarily modify the dose and/or
regimen, for example using patient interface 905.
Optionally, the extent of
modifications is limited, to prevent a condition in which the patient is at
risk, for
example preventing overdosing.
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In some embodiments, the patient may simply use MDI device 901, even when
not specifically instructed to. In such a case, the next dose and/or regimen
may be
automatically modified in response to the usage. Optionally, the patient is
notified
about modifications in the dose and/or regimen through patient interface 905.
5
Additionally or alternatively, the physician is notified about such changes,
for example
through physician interface 903.
Figure 2 is a flowchart of a method for prescribing a regimen to a patient
using
an MDI device for delivery of at least one active agent, according to some
embodiments
of the invention.
10 In some
embodiments, a physician may decide to treat a patient by effecting a
pulmonary delivery of one or more active agents by an MDI device (1001).
In some embodiments, patient data such as one or more of, for example, PK
variables (e.g., age, gender, BMI etc.), pathophysiological status,
pharmocogenetic
and/or pharmacogenomic variables and/or other parameters are inserted to the
system
15 (1003),
for example by the physician and/or other clinical personnel. Optionally, the
patient's parameters and personal variables are inserted using the physician
interface.
In some embodiments, a suggested dose and/or regimen is generated (1005).
Optionally, the dose and/or regimen is generated automatically, for example by
software
of the physician interface. Additionally or alternatively, the dose and/or
regimen is
20 planned
by the physician. In some embodiments, the dose and/or regimen is generated
by matching the inserted patient data to a pre-defined dose and/or regimen
using data
from a database, or according to personal feedback data, or for example
according to a
look up table.
In some embodiments, a simulation of an expected PK/PD profile of the patient
25 for the
selected dose and/or regimen is produced (1007). In some embodiments, an
expected PK/PD profile, including for example therapeutic effects and/or
adverse
effects is simulated. In some embodiments, by correlating between the
pharmacodynamic profile and/or pharmacokinetic profile and the patient's
personal
data, a therapeutic window is selected. Optionally, the PK/PD profile
simulations
30 and/or
the pre-selected therapeutic window are graphically displayed to the
physician,
for example on a display of the physician's interface. When considering the
simulations,
a physician may decide to modify the dose and/or regimen to better suit
(personalized) it
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to the patient (1009). In some cases, the physician may decide to change
proposed dose
and/or regimen parameters such as one or more of dose, dosing, regimen or
total
treatment duration, and/or other treatment parameters.
In some cases, treating includes administering two or more substances,
simultaneously or sequentially, to obtain a desired therapeutic effect in the
patient. The
system, according to some of any of the embodiments of the present disclosure,
provides the ability to use the MDI for delivering more than one
pharmaceutically
active agents (from one or more substances) at any ratio or pre-determined
vaporized
amounts so as to exhibit a pre-selected PD profile (e.g., maintaining an
individual
patient within the therapeutic window calculated per the patient). In
some
embodiments, different doses are selectively administered according to a
regimen so as
to prevent adverse effects while still alleviating symptoms.
In some embodiments, the selected (and optionally refined) dose and/or regimen
is prescribed to the patient (1011).
In some embodiments, as a follow up and over a time period in which the
patient
is treated (e.g., over several hours, over a day, over a week, over a month,
and/or
intermediate, longer or shorter periods), the physician receives one or more
indications
such as indications relating to the patient's general usage of the device,
indications
relating to dose and/or regimen administered to the patient, substance
consumed by the
patient, one or more personal PD effects of the patient, for example relating
to the
presence of adverse effects, such as the psychoactive level and/ or
indications relating to
the symptom intensity such as the pain level, and/or a level of one or more
biomarkers
and/or other indications (1013). Optionally, one or more indications are
provided in
real-time. Additionally or alternatively, the indications are provided at the
end of a
pulmonary delivery of the agent. Additionally or alternatively, the
indications are
provided on demand of the physician. Additionally or alternatively, the
patient decides
when to send indications to the physician.
In some embodiments, the indications are transmitted to the physician by the
MDI device and/or by the patient interface, automatically and/or in response
to an
instruction from the physician and/or the patient. Optionally, one or more
indications
are stored in the database for future reference.
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In some embodiments, based on the provided indications, the dose and/or
regimen is adjusted or otherwise modified (1015). Optionally, modification is
performed in real-time. In some embodiments, a specific dose and/or regimen is
modified, optionally in real-time. In some embodiments, the dose and/or
regimen is
modified while taking into account upper and lower PD effect limits defined
individually per the patient. An upper limit may allow dose and/or regimen
above which
substantial adverse effects are present. A lower limit may allow dose and/or
regimen
below which a symptom, which was intended to be treated by delivery of the
active
agent, is not sufficiently alleviated.
Figure 3 is a flowchart of a method for obtaining feedback data from a patient
and modifying/adjusting a dose and/or regimen accordingly, according to some
embodiments of the invention.
In some embodiments, a personal PD effect of the patient is obtained (1201).
In some embodiments, the PD effect relates to an adverse effect such as a
psychoactive level, a therapeutic effect such as a pain level, and/or a change
in any of
those levels thereof. The PD effect may include an absolute quantification of
the level,
and/or a relative quantification of the level, assessed, for example, with
respect to a
level measured before a delivery of single dose and/or before a delivery of
dosing
and/or regimen. The PD effect may be obtained before, during and/or after a
delivery of
single dose and/or before, during and/or after a delivery of dosing and/or
regimen and/or
before, during and/or after a general time period over which treatment is
provided to the
patient.
In some embodiments, the PD effect is provided directly by the patient, for
example using the patient interface. In some embodiments, the patient can
manually
adjust a visual representation of the PD effect, based on a personal
determination of the
level of the PD effect. In an example, the patient may raise or lower a bar on
a graph
indicating a pain level, for example on a touch screen of a cellular phone
and/or any
other personal device on which the patient interface is configured.
In some embodiments, patients who are unable to articulate levels of the PD
effect may utilize an interactive set of tools to assist them in determining
their current
level of the PD effect, for example as further described herein.
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Additionally or alternatively to a conscious, personally perceived PD effect
indicated by the patient, a personal PD effect such as a biomarker is obtained
by the
patient interface and/or by the system, for example using a sensor. In some
embodiments, one or more standard components of a cellular phone and/or
personal
computer on which the patient interface is configured as acts as a sensor for
obtaining
the parameter. Some components which may be used as sensors for obtaining PD
effects from the patient may include: a touch screen, may be used for example
to assess
dexterity, eye-hand coordination, and/or a memory and cognition state; a
gyroscope,
accelerometer, proximity sensor and/or gesture sensor such as IR sensor may be
used,
for example, to assess motor skills; a camera and/or light source may be used,
for
example, to detect visual tracking, saccade variance, eye vascular expansion,
pupil
dilation and/or pulsation; an RGB illumination may be used, for example, to
assess
environmental perception; a magnetometer and/or GPS may be used, for example,
to
assess orientation; a speaker and/or microphone may be used, for example, to
assess
auditory and/or vocal skills; a temperature and/or humidity sensor may be
used, for
example, to assess a body temperature.
In some embodiments, the MDI device is configured to obtain personal feedback
data. In an example, the MDI device comprises a flow sensor and/or a pressure
sensor.
Optionally, a breathing related indication of the patient is obtained using
the
flow and/or pressure sensor. In some embodiments, the sensor is adapted to
detect a
volume of inhalation. Since a correlation may exist between inhalation volume
and a
PD effect, such as a pain level, in some embodiments, a flow and/or pressure
measurement is initiated to determine a PD effect in the patient.
Once one or more personal PD effects are obtained, the dose and/or regimen
may be modified accordingly (1203). In some embodiments, the dose and/or
regimen is
modified, on one hand, to improve or otherwise change a condition of the
patient based
on the provided indication, and, on the other hand, to achieve a pre-selected
pharmacodynamic profile, such as maintaining the patient within the
therapeutic
window ¨ between a lower limit of a therapeutic effect that provides symptom
relief,
and a higher limit of an adverse effect in which the adverse effect level is
still tolerable.
In some embodiments, the MDI device can be configured such that when below a
minimal therapeutic effect, input by the patient may increase the dose and/or
adjust the
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regimen in frequency and/or in quantity. Optionally, the dose and/or regimen
is
modified to obtain a level above a minimal therapeutic effect. Additionally or
alternatively, the dose and/or regimen is modified as much as the maximal
level of an
adverse effect permits.
Figure 4 is a schematic diagram of a metered dose inhaler device configured to
provide automated controlled pulmonary delivery of one or more active agents,
according to some embodiments of the invention. Patent publications
W02016/001923,
W02016/001925, W02016/001926, W02016/001921 incorporated herein by reference,
describe devices and/or systems that may be used within the framework of some
embodiments of the present application.
In some embodiments, device 1601 comprises substance dispenser 1603, e.g., a
dispenser for the substance that contains the pharmaceutically active agent
and allows
the pharmaceutically active agent to be inhaled therefrom. In some
embodiments, the
substance dispenser comprises, or is in communication with, a source of at
least one
substance from which the active agent originates, and a mechanism for
processing the
substance to obtain a deliverable active agent, for example as described
hereinabove.
The substance may comprise various forms, such as, for example, a solid bulk,
solid particles, a solution or a powder. Optionally, the substance is
contained within a
cartridge, a capsule, and/or other containers. In some embodiments, the
processing
mechanism includes one or more of, for example, heating (e.g., for
vaporizing), turning
to aerosol, causing a chemical reaction, for example by mixing with other
materials,
releasing substance from a container such as by breaking open a capsule,
pressure
propellant, mobilizing and/or other types of processing. Alternatively, the
active agent
is already in a ready to use form and does not require any processing before
delivering
to the user by heating the substance.
In some embodiments, MDI device 1601 comprises input module 1605.
Optionally, input module 1605 is configured to receive data pertaining to a
dose and/or
a regimen according to which the active agent will be delivered to the
patient.
Additionally or alternatively, input module 1605 is configured to receive one
or more
indications from a sensor (not shown in this figure), comprised within device
1601
and/or configured externally to device 1601.
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In some embodiments, MDI device 1601 comprises a controller 1607,
configured to initiate and/or modify and/or cease the pulmonary delivery of
the
pharmaceutically active agent. In some embodiments, controller 1607 operates
substance dispenser 1603, for example activating heating of the substance by a
heating
5
element. In some embodiments, controller 1607 activates delivery of a pre-
determined
vaporized amount of the agent, such as the dose and/or regimen received as
input. In
some embodiments, controller 1607 controls the flow of the active agent, for
example
by activating one or more valves. In some embodiments, the controller is
adapted to
release the agent based on a current flow rate.
10 In some
embodiments, MDI device 1601 comprises an output 1609. Optionally,
output 1609 is configured as a mouthpiece to be engaged by the patient.
Alternatively,
to a mouthpiece, output 1609 may be configured as a breathing mask, a pacifier-
like
attachment for infants, and/or other structures suitable for delivering the
flow of vapors
to the patient.
15 In some
embodiments, components of device 1601 such as the substance
dispenser and/or the controller and/or other components are contained within a
housing
1611. Optionally, the housing is shaped and sized to be used as a handheld
device.
In some embodiments, MDI device 1601 comprises a flow control mechanism.
Optionally, the flow of vapors is controlled using one or more valves. In some
20
embodiments, the flow is selected and/or modified per the individual patient,
for
example by timing the delivery and allowing flow of the active agent to the
patient only
during inhalation of the patient, indicated for example by a sensor
incorporated in the
MDI device. In some embodiments, the device is configured to modify the flow
to allow
the patient to instinctively identify when to cease inhalation, inhale deeper,
and/or
25
otherwise change the breathing rhythm and/or intensity. In an example, a pulse
of
increased flow volume is delivered by the device to indicate to the patient to
cease
inhalation.
In some embodiments, the flow is selected and/or modified to reduce an amount
of active agent that remains trapped within the outflow tract of the device,
and is not
30
delivered to the patient. In some cases, the amount of trapped active agent is
reduced to
a known, predefined amount by controlling the flow.
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In some embodiments, the flow is controlled by controller 1607. Optionally,
the
flow is controlled according to data received on input module 1605, data
acquired by a
sensor, and/or other indications.
A potential advantage of a device comprising a flow control mechanism which is
operable per an individual patient may include improved accuracy of delivery
to the
patient, with respect to timing and/or pre-determined vaporized amounts of
active agent
delivered by the device, improving the performance of the system/MDI device.
Figure 5 is a schematic diagram of a configuration of an MDI device 1701,
according to some embodiments of the invention.
In this configuration, the substance dispenser 1703 comprises a substance
cartridge 1705, a heating element 1707, and a feeder 1709 which moves the
substance
cartridge relative to the heating element 1707, for example to be in contact
with or in
proximity to the heating element.
In some embodiments, the heating element is configured to provide localized
heating, for example by conduction, convection and/or radiation. In
some
embodiments, a substance is heated sufficiently quickly to a temperature
suitable for
forming vapors of a vaporizable pharmaceutically active agent contained
therein. In
some embodiments, the substance is organized as a moving element, which can be
selectively and/or locally activated. Optionally, the substance is organized
into
compacted shapes. Optionally, each shape represents a pre-determined vaporized
amount.
In some embodiments, the vapors released from the substance collect within a
vapor chamber 1711, from which they travel to the patient through an outflow
tract.
Optionally, a valve 1713 is positioned along the tract to control the rate of
flow.
In some embodiments, device 1701 comprises a mouthpiece 1715 from which
the vapors are delivered to the patient in response to inhalation.
Alternatively,
mouthpiece 1715 can be attached to other elements, for example, to a mask
and/or nasal
cannula, optionally with supplemental oxygen, for example, to deliver therapy
to
debilitated patients. Optionally, mouthpiece is in fluid communication with
valve 1713.
In some embodiments, device 1701 comprises a power source 1717, for example
a battery, a manually wound spring, and/or a wall socket plug.
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In some embodiments, device 1701 comprises a controller 1719, for example as
described hereinabove, configured to control one or more of valve 1713, power
source
1717, and/or the substance dispenser 1703 as a whole and/or separately control
the
components of the substance dispenser. In some embodiments, controller 1719
verifies
that a substance cartridge is authorized for use.
In some embodiments, controller 1719 is in communication with memory 1721,
which can be read by the controller and/or be written in.
Figure 6 a flowchart of a method of treating an individual patient using a
system
according to Fig. 1, while maintaining the patient within a therapeutic
window,
according to some embodiments of the invention.
In some embodiments, the MDI device is programmed with a pre-determined
vaporized amount (dose and/or regimen) (1801). Optionally, the dose and/or
regimen is
set in the inhaler device by the physician, manually (such as by activating
buttons on the
device itself) and/or using the physician interface. Additionally or
alternatively, the
.. dose and/or regimen is set in the MDI device according to instructions sent
from the
patient interface.
In some embodiments, the MDI device is optionally configured for selecting at
least one pre-determined vaporized amount for an inhalation session, which can
include
a plurality of inhalations, based on the dose unit's contents, and controlling
at least one
of heating and airflow in the device to control the pre-determined vaporized
amount of
an active agent provided to the user. In other words, based on the properties
of the
substance, which is packed into the dose unit, namely the amount of active
agent(s)
available therein for vaporization, the device can be configured to vaporize
some or all
of the available active agent(s) in the substance in a single or a plurality
of inhalations,
wherein the controllability over the vaporized amount in each inhalation is
afforded by
control over the heating level and duration, and the airflows output and
duration in the
device.
In some embodiments, the MDI device is activated to deliver the active agent
to
the patient (1803). In some embodiments, direct and/or indirect feedback data
from the
patient is obtained in real-time (1805). Optionally, feedback data is obtained
during a
pulmonary delivering (an inhalation session). A treatment may typically start
with a
pulmonary delivery, and end between 5-20 minutes thereafter, for example when
the
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pre-selected pharmacodynamic profile has fully manifested for the active agent
and/or
at a later time. Additionally or alternatively, feedback data is obtained over
a series of
pulmonary deliveries, for example over a time period of 1 hour, 3 hours, 5
hours, 9
hours, 12 hours or intermediate, longer or shorter time periods. A protocol
may include
5-10 pulmonary deliveries per day, in time intervals ranging between 15-180
minutes
between successive pulmonary deliveries.
In some embodiments, the feedback data which is obtained from the patient
includes personal PD effects such as therapeutic effects, for example symptom
intensity,
and/or adverse effects, for example a psychoactive state of the patient.
In some embodiments, the patient interface interacts with the patient to
obtain
the feedback data. In some embodiments, questions to the patient relating
their current
state are displayed on a screen, and the patient answers the questions. Such a
question
may be presented, for example, in the form of a bar indicating a pain level,
for example,
which the patient raises and/or lowers. Additionally or alternatively,
feedback data is
obtained by one or more applications, such as games, which the patient
interacts with.
Optionally, non-invasive biomarkers levels are estimated by analyzing the
patient's
input when interacting with the user interface. Additionally or alternatively,
feedback
data from the patient is obtained by measuring various biomarkers using one or
more
sensors, for example by utilizing components of a smartphone, a handheld
device, a
wearable device, a wrist device or an integrated eyewear device, to act as non-
invasive
biomarker sensors.
In some embodiments, the personal PD effects are obtained periodically, for
example semi-daily, daily, weekly, monthly, per demand such as before a dose
and/or a
series of doses, before and/or after alterations in dosing and/or regimen, or
others.
In some embodiments, in response to the PD effects, a dose and/or regimen is
modified (1809). Optionally, the dose and/or regimen is modified to achieve a
desired
effect, for example reduce pain level of the patient, while maintaining the
patient within
a therapeutic window. In some embodiments, the dose and/or regimen is
iteratively
modified by the patient interface. Modifications may take place a plurality of
times, for
example during, between or after one or more pulmonary deliveries, and/or over
a total
treatment time period (days, weeks, months, years) over which the patient is
treated.
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The modification is limited by safety cutoffs, such as doses which may put the
patient at
risk.
In some embodiments, the patient interface and/or the MDI device remind the
patient to perform one or more pulmonary deliveries (1811). Such a reminder
may be
provided as a visual signal (for example light indication), a sound, a
vibration, a
notification on a portable/handheld device, e.g. smartphone, a handheld
device, a
wearable device, a wrist device or an integrated eyewear device, or a
combination
thereof.
In some embodiments, usage data of the patient is recorded and stored in the
MDI device memory and/or in the patient interface memory. Optionally, the
delivery of
the active agent is modified, potentially in real-time, according to usage
data. For
example, in a case in which the patient missed one or more pulmonary
deliveries, the
dose and/or regimen may be automatically modified to set a delivery of, for
example, an
increased amount of active agent in the following one or more pulmonary
deliveries. In
some embodiments, the record is transmitted to a physician which in turn
updates the
regimen and/or prescribes drug supply. Optionally, usage is recorded on a
cartridge and
is read when the cartridge is collected from the user.
Some potential advantages of recording use may include following up on
treatment, improving treatment, reducing misuse and/or abuse which in some
cases may
lead to addiction.
In some embodiments, any one or more of the actions described in 1801-1811
may be repeated. Advantageously, obtaining personal PD effects and/or usage
data from
the patient repetitively may provide for ongoing adjustment of the dose and/or
regimen,
providing a flexible, precise and accurate personalized treatment to the
patient based on
an actual effect of the treatment on the individual patient.
The following is an example for a procedure for determining and administering
a
personal dosing and/or regimen for treating a human subject by pulmonary
delivery
using an inhaler device, according to some embodiments of the present
disclosure. The
procedure is depicted in flowchart 1900 presented in Fig. 7.
Providing patient data (see, 1901 in Fig. 7) may include information about the
patient's properties, including for example one or more of the patient's age,
gender,
weight, BMI, expected activity, etc., a recommended dosage and/or regimen
and/or a
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syndrome or indication for which treatment is administered. Optionally,
providing
patient data (1901) also includes PK/PD data from one or more previous uses of
an
inhaler for the same active agent(s) and possibly also for the same
indication.
Optionally, providing patient data (1901) includes a correlation or set of
correlations
5 between
a dose and the PK profile and/or PD profile of the patient over a period of
time
as recorded in one or more previous deliveries of the same one or more
pharmaceutically active substances. Optionally, providing patient data (1901)
includes
data assembled from PK/PD profiles of a plurality of users or a population to
which the
user belongs.
10
Optionally, providing patient data (1901) includes treatment instructions
and/or
treatment preferences. Some examples for treatment instructions or preferences
may
include no dose during a given temporal window; allowing more drowsiness
generally
(e.g., for bedridden patients) or at a given time (e.g., initial treatment
and/or during the
night and/or when dealing with extreme symptoms); requiring alertness in given
15
timeframe (e.g., when a patient expects to need alertness), and the like. Such
instructions may be given a weighted value; for example, a patient may be less
adamant
on some instructions then others, for example the patient may prefer having
more
drowsiness in the evening, but may indicate that he must be alert for a test
at 10 AM.
The instruction may have a relative effect in the sense that some effects may
be
20
tolerated to a certain degree only in order to comply with a given
instruction. For
example a patient may instruct that he must be alert for driving unless pain
is above a
certain given value.
Still encompassed by optional providing patient data (1901), treatment
instructions may be provided at any time during a period of treatment; for
example,
25 before beginning treatment a patient may provide treatment instructions
and/or
treatment preferences. At any time thereafter, a patient may input additional
indications
and/or preferences. For example, a patient may, at any time, use a user
interface
associated with the device to instruct regarding a future (e.g. next) dose (or
more than
one dose). Such instruction may include that a dose will not be taken in a
given window
30 of
time, or must be taken before a given time point, etc. Optionally such
instruction
may include an adjustment of the user's acceptable and/or preferred
therapeutic window
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what constitutes a sufficient therapeutic effect and/or what constitutes a
maximal level
(tolerable) of an adverse effects.
Optionally, providing patient data (1901) is updated to reflect when a dose
was
inhaled, the dose amount and/or how the device operated in the inhalation
event (e.g., if
inhalation was successful or failed due to a device malfunction and/or
improper usage).
This may be taken as an indication of user status and/or device malfunction
and/or
amount of active substance inhaled (efficiency factor). Such data may be used
to adjust
the regiment and/or issue a notification to the user and/or medical
practitioner.
Optionally, when a regimen calls for the user to administer a dose, the user
may
be prompted to do so, visually and/or by sound, via at least one user
interface. When
prompted, the user may have the option to defer by selecting a "snooze" option
and
optionally set the next time when he would take the next dose. In response,
the device
may readjust the regimen (e.g., next dose size and timing) and/or provide a
notification
to the user that this would not be possible or is likely to have a given
adverse effect.
Optionally, if a user misses a time slot allotted for a given dose, one or
more of
the following may take place: (a) the regimen is adjusted to compensate for
the delay;
(b) a notification is given to the user (possibly by way of an alarm and/or
vibration); (c)
a notification is given to a care giver and/or a medical practitioner.
Generating initial dosing and/or regimen (see, 1902 in Fig. 7) may be effected
as
follows:
Based on recommended dosing and/or regimen (see details below) and patient
data (1901), an initial dosing and/or regiment (1902) is proposed. The initial
dosing
and/or regimen (1902) may include the recommended dosage according to known
standards and/or may be adjusted by taking into account data related to the
patient's
previous treatment(s) using an inhaler and the treatment instructions and/or
preferences.
Taking into account the recommended dosing and/or regimen, treatment
instructions may include some constraints that are more stringent than others.
For
example, a maximal allowed dose may not be exceeded regardless of user's
preferences,
and the device may be configured not to allow overdosing. Similarly, a minimal
mandatory dose may be prescribed and should not be avoided regardless of
user's
preferences, and the device may be configured to issue a non-compliance alert
to the
user and/or care giver and/or medical staff in such cases. Optionally, the
constraints
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may be imposed in advance (e.g., based on a therapeutic index of the one or
more active
substances and/or in accordance with a plan plotted or approved by a
physician) and/or
periodically or on an ongoing basis (for example as a result of specific
events
encountered by the user's use of the device).
Optionally, generating initial regimen (1902) is effected for a patient when
first
assigned with an inhaler and a regimen. In such case the patient is required
to inhale the
first dose or first several doses under supervision (e.g., for a period of 2
hours or more).
During this time period the patient's symptoms and PD effects are observed,
recorded
and measured before the first dose and then occasionally at least for the
supervised
period. Additionally or alternatively, one or more inhalations are monitored
by blood
tests to extract some PK effects or a full PK profile. This may include
administration of
several different doses in order to establish a personalized initial dosing
and/or regimen.
When PK effects are taken and analyzed, a first correlation (blood
concentration over
time as a function of the pre-determined vaporized amount/dose) may be
recorded. This
correlation may remain the same for a given patient as long as no major weight
change
or changes in kidney and/or liver function occurs. A second correlation, such
as a PD
effect as a function of blood concentration over time, may be used as it is
known for the
population at large. Based on the two correlations an individual initial
dose/PD
correlation over time may be determined per patient. Optionally, a direct
correlation is
measured and used for a given patient, between a PD effect over time as a
function off
the pre-determined vaporized amount/dose.
Receiving PKPD feedback (see, 1903 in Fig. 7) is effected to include at least
one
of several classes of user indications/information, including user semi-
controlled
(voluntarily or involuntarily) indication and user uncontrolled
(involuntarily) indication.
Receiving PKPD feedback (1903) may include receiving user-controlled
indication and/or information, wherein the user may provide input regarding
the
perceived and/or sensed effect and/or a desired range of effect. For example,
inputting
one or more responses to interrogation via the device's user interface and/or
by a
practitioner (e.g., grade a degree of pain and/or a degree to a psychoactive
effect), while
the user has control on the input he provides. A response may include grading
on a
scale (e.g., a scale of pain from 1 to 10), a Yes/No response (e.g., whether
nausea was
removed or if food was eaten without vomiting) and/or a temporal description
of an
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effect ("when did you notice that pain began to dissipate?", "how did the pain
feel
during the time from inhalation to interrogation?" etc.). The interrogation
may be
periodic (e.g., once a day or every several hours or upon inhalation or as a
requirement
before inhalation) and may be limited to only a part of the period of
treatment. For
example, interrogation may cover the initial 6, 12 or 24 hours in order to
determine a
regimen and then repeated periodically (e.g., once a day or once a week or
once a month
or upon desire) in order to confirm the regimen and/or readjust it in view of
progress.
Receiving PKPD feedback (1903) may include receiving user semi-controlled
indication, wherein the user may participate in measuring the user's status;
while user
compliance is needed for these indications, the user has little or no control
on the result.
For example, a user may be instructed to attach a sensor to his body that
communicates
with the device or allow sensing a property (e.g., eye redness). Optionally
and
alternatively, a user interface may test the user, for example by following
pupils and/or
instructing the user to perform a task. Examples for tasks may include,
without
limitation, following a mark on a screen with your eyes; dragging a mark on a
screen
through a pattern without touching walls; completing mental tasks (such as
solving
mathematical equations or answering questions); testing memory by games; and
testing
concentration.
Receiving PKPD feedback (1903) may include receiving user uncontrolled
indication, wherein the inhaler or a device associated with the inhaler may
sense one or
more properties of a user as an indication of the user's status and use that
as an
indication of one or more effects of the inhaled dose regimen on the user. For
example,
sensing mouth temperature during inhalation and/or pupil size without
prompting the
user, each of which may indicate PD effect and thus serve as a PD effect;
sensing
tremor or a variation in tremor; and sensing heart rate and/or blood pressure,
for
example by interaction with a sensor worn by the user and/or implanted in the
user.
Optionally and alternatively, sensing airflow properties in the device may be
used as an indication of the user's status, wherein such air flow properties
may include
one or more of flow rate and/or the rate of increase in flow rate and or a
degree and/or
rate of variation in flow during an inhalation event. For example, considering
changes
from one or more baseline values, which may indicate for example an
improvement or a
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decline in wellbeing (e.g. as manifested by strength and/or pain that may
affect the
inhalation properties/patterns for the user) and/or concentration or
attention.
Generating adjusted regimen (see, 1904 in Fig. 7) is effected if needed, to
generate an adjusted dosing and/or regimen. An adjusted dosing and/or regimen
may be
required when one or more of the following occurs:
1. One or more treated symptoms is not sufficiently alleviated;
2. One or more psychoactive effects exceed a given threshold
3. The therapeutic/adverse effect balance is below a given threshold;
and/or
4. A change in circumstances that needs to be taken into account occurs
(e.g. breakthrough pain or a missed inhalation event).
It is noted that a given activity of an agent may be regarded as a desired
effect or
an undesired effect inter alia in different circumstances and for different
subjects. For
example, an active agent that is analgesic, sedative and/or hallucinogenic it
may be that
the analgesic property is a therapeutic effect and the hallucinogenic property
is an
adverse effect. As for sedation, in some circumstances this might be a desired
effect of
treatment while in others it may be undesired.
Optionally and alternatively, in generating adjusted regimen (1904), the
dosing
and/or regimen includes a second active agent (or more than two agents) that
is co-
administered in order to reduce an undesired side effect of the drug.
Figure 8 is a flowchart of a method for treating a patient with a low dose of
THC, according to some embodiments of the invention.
In some embodiments, a decision is made (e.g. by a physician) to treat a
patient
by pulmonary delivery of THC (2200).
In some embodiments, cannabis and/or another material comprising THC (for
example synthetic THC, a THC extract, and/or a pallet of inert material
comprising
THC) is heated to vaporize the THC, for example using methods and/or devices
as
described hereinabove. (2202).
In some embodiments, cannabis and/or other THC-comprising material is
selected to have a certain THC content, for example between 3-25% THC, between
5-
50% THC, between 20-70% THC, or intermediate, higher or lower THC content.
Optionally cannabis having at least 10% THC or at least 20% or even 25% THC is
used.
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In some embodiments, THC is extracted from THC-comprising material at a
selected efficiency. Optionally, the efficiency is fixed for a given inhaler
device.
Alternatively, the device is configured to control one or more extraction
parameters
thereby to modify extraction efficiency. Optionally, a device such as the
inhaler
5 described hereinabove is controlled to extract THC from cannabis at an
efficiency of,
for example, at least 60%, at least 25%, at least 40%, at least 75% or
intermediate,
higher or lower efficiencies. In some embodiments, the amount of THC-
comprising
material is selected according to the extraction efficiency and/or according
the THC
content in the THC-comprising material, for example for a 60% extraction
efficiency
10 the selected amount of cannabis would include THC at about twice the
amount of THC
delivered to the patient. In an example, for extracting a 2 mg THC dose, an
amount of
cannabis comprising about 3.33 mg needs to be heated. In some embodiments, the
amount of THC-comprising material is such that it contains THC at an amount
that is no
more than twofold a maximal amount of THC that is to be delivered to the user
from the
15 material or no more than 1.5 times the maximal amount of THC that is to
be delivered.
In some embodiments, a dose of between 0.2-2 mg THC is provided to the
patient (2204). Optionally, the low dose is delivered within any time period
of two
hours or more. In some embodiments, the low dose is delivered in a single
delivery
event. Alternatively, the low dose is delivered over a plurality of delivery
events.
20 In some
embodiments, a "single delivery event" refers to an event over which a
single low dose is delivered to the patient through inhalation. In some
embodiments, a
single delivery event refers to one activation of an inhaler device over which
the dose is
delivered to the patient, comprising, for example, heating of sufficient
material to
extract the dose and allowing flow of the vaporized THC to the patient. A
"single
25 delivery event" may include one inhalation of the patient.
Alternatively, a single
delivery event may include a plurality of inhalations performed within a time
period
short enough so as to be considered as a single event. Optionally, each
delivery event is
coupled with an activation of heating, which is reduced or terminated between
delivery
events. Optionally, each delivery event includes extracting THC from a
separate
30 cartridge or a separate THC-comprising material source.
Optionally, a single delivery event includes only one inhalation, and
optionally
a single inhalation is shorter than 3 seconds. Since inhalation may vary
between patients
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depending on, for example, a depth of inhalation, puff duration, breath hold
time,
volume intake and/or other parameters, a single delivery event is generally
referred to
herein as an event in which a pre-determined dose of THC is delivered to the
patient
through inhalation, according to some embodiments.
In some embodiments, a single dose is delivered in a single delivery event.
Optionally, the single dose is provided from a plurality of sources of THC-
comprising
material(s). In an example, the single dose is provided by heating a plurality
of
cartridges, simultaneously and/or in sequence.
In some embodiments the period of time between an inhalation of a first dose
portion and an inhalation of a second dose portion is sufficiently short to be
regarded as
a single delivery event. Optionally, a number of inhalations takes place
within 5-30
minutes or within under 15 minutes or even within under 5-10 minutes.
Optionally,
each inhalation in such "rapid succession" delivers to the user a different
amount or a
composition. Optionally, two or more of the inhalations provide the same
composition
and amount. In some embodiments, an inhalation of a second dose portion is
performed
at such timing that a first dose portion inhaled previously still induces at
least one PD
effect in the subject. In some embodiments, delivery in rapid succession means
that the
inhaled dose portions have essentially the same effect as they would have had
if inhaled
in a single delivery event.
In some embodiments, control over the amount of THC delivered is provided by
programming a controller of an inhaler device (for example, but not limited
to, an
inhaler as described hereinabove) to limit the amount of THC to 2 mg or less
by one or
more of: controlling heating parameters (e.g. duration, temperature, rate,
heating
pattern), controlling the amount of cannabis and/or other THC-comprising
material
being heated, regulating airflow (e.g. to the user and/or through the THC
comprising
material) and/or combinations thereof. Additionally or alternatively, control
of the
amount of THC delivered is provided by heating a cartridge which is pre-packed
with
an amount of cannabis and/or other THC-comprising material from which 2 mg THC
or
less can be extracted.
In some embodiments, the cartridge comprises cannabis comprising THC at an
amount equal to or smaller than two fold or 1.5 fold the amount of THC to be
delivered.
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Optionally, the cartridge comprises cannabis at an amount including no more
than 6 mg THC, no more than 8 mg THC, no more than 4 mg THC, no more than 1 mg
THC, or intermediate, larger or smaller amounts. Optionally, a single dose
cartridge is
used to provide THC for more than a single delivery event and/or more than a
single
inhalation.
In some embodiments, after the low dose is delivered to the patient via one
delivery event, THC is not provided again for at least 2 hours. Optionally,
the two hour
period begins immediately after the last inhalation of the delivery event.
Optionally,
THC is not provided for at least 3 hours, at least 5 hours, at least 7 hours,
or
intermediate, longer or shorter time periods. In some embodiments, no more
than
between 0.2 mg to 2 mg THC is delivered within a two hour time period,
optionally at a
single delivery event. Optionally, the amount is between 0.1 and 0.75 mg
within a two
hour time period or between 0.1 mg and 0.5 mg within a two hour time period.
In some embodiments, the next dose, delivered after at least two hours,
comprises 2 mg or less THC (2206), or 1 mg or less or 0.5 mg or less.
In some embodiments, no more than 8 delivery events, 6 delivery events, 4
delivery events or intermediate, or lower number of delivery events are
provided over a
day, wherein in each event 2 mg THC or less are delivered to the patient.
In some embodiments, a total of no more than 10 mg THC, no more than 7.5 mg
THC, no more than 6 mg THC, no more than 4 mg THC, no more than 2 mg THC, no
more than 1 mg THC or intermediate or smaller amount of THC is delivered over
a day.
In some embodiments, between 0.5-1 mg THC is delivered 3 or 4 times a day. A
time
period of a "day" as described herein may refer to waking hours, for example a
time
period of 10 hours, 11 hours, 12 hours, 14 hours. Alternatively, a "day" as
referred to
herein may include night hours as well, therefore a time period of 24 hours.
In some embodiments, the amount of THC delivered at a single dose and/or at a
plurality of doses and/or over a day is adjusted according to one or more
personal
parameters such as age, weight, THC sensitivity, severity of symptoms,
concurrent
medication, personal preferences and/or tolerances. In an example, an
inexperienced
user may prefer a 0.5 mg dose rather than, for example, a 2 mg dose, since the
0.5 mg
dose would have a reduced psychoactive effect on the user than the higher
dose. In
another example, a child might be prescribed with very low doses, for example
between
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0.2 mg and 0.5 or 1 mg, while optionally taking into account other parameters
relating
to the child.
In some embodiments, the actual amount of THC delivered (selected for
example from the range of 0.2 mg to 2 mg) is set by the physician and/or by
the user,
and may vary throughout the day. In an example, the user may decide to inhale
smaller
amounts (e.g. 0.1 mg, 0.2 mg, 0.5 mg, 0.7 mg) during the day, so that the
psychoactive
effect will be relatively low and will interfere less with daily activities
(e.g. driving),
and inhale larger amount(s) (e.g. 1.5 mg, 2 mg) in the evening. Optionally, a
physician
may set a maximum dosage while a user will have the freedom to inhale less
than the
prescribed amount, optionally according to his symptom (e.g pain) intensity at
that
moment and/or according to his need for clarity or aversion to a psychoactive
effect.
In some embodiments, THC is delivered concomitantly and/or sequentially with
one or more other drugs, including for example one or more cannabinoids. In an
example, an inhaler device for example as described herein is configured to
deliver a
0.2-2 mg dose of THC, and to deliver one or more other active substances
before,
during and/or after delivery of the THC.
It has been shown by inventors in experiments performed that an inhaled THC
dose of 0.2-2 mg may provide sufficient symptom alleviation for a time period
of at
least 2 hours, at least 3 hours, at least 4 hours, at least 6 hours or
intermediate or longer
time periods. In some cases, symptoms such as pain and/or nausea were reduced,
for
example reduced by 30%, 50%, 70% or intermediate, higher or lower percentages
without return of the symptom to a pre-inhalation degree for a time period of
at least 2
hours. Other examples of symptoms which may be alleviated by prescribing a low
dose
regimen may include adverse effects of chemotherapy and/or vomiting and/or
weight
loss and/or insomnia and/or euphoria and/or drowsiness and/or psychomotor
effects
and/or cognitive effects, and/or agitation and/or depression.
Cancer patients suffering from advanced symptoms and/or side effects of
chemotherapy were treated in accordance with the above described regimen,
being
delivered a dose of between 0.2-2 mg THC at a single delivery event and
waiting at
least two hours before the next dose. The patients voluntarily reported their
conditions.
In a first case, a 28 year old female cancer patient was admitted to hospital
for
chemotherapy. She was previously prescribed cannabis for pain, vomiting,
nausea and
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weight loss, which she took by smoking cigarettes. Unfortunately, the
cigarettes did not
alleviate her symptoms sufficiently. In the experiment, the patient was
prescribed
3X0.5 mg THC per day, delivered using an inhaler device for example as
described
hereinabove. The first dose was to be taken 30 minutes before chemotherapy.
The
patient was allowed to take additional inhalations as needed. In the day of
the
experiment, after receiving chemotherapy as planned, the patient was eating,
was free of
nausea and vomiting and had significantly improved mood. The patient inhaled
the 3
prescribed doses only, and no other medication was prescribed or taken. Later,
the same
patient readmitted to hospital for an additional round of chemotherapy. This
time she
chose to inhale THC in four 0.5 mg doses, a first dose in the morning before
chemotherapy, second and third doses taken concomitantly at midday (amounting
to a
single 1 mg dose) and a fourth dose in the evening. Again, the treatment was
shown to
be effective.
In a second case, a 50 year old male cancer patient was admitted to the
hospital
for severe pain and in order to resume treatment that he chose to terminate
earlier. He
was previously prescribed cannabis for pain, cachexia and nausea, in addition
to other
drugs. Throughout the treatment, he received a continuous morphine drip (400-
600 mg)
with additional morphine treatment upon need. Before being hospitalized, he
had not
eaten for a week, suffered from sleep deprivation and was depressed. In the
hospital he
was provided with an inhaler for example as described hereinabove and during
the first
day of use he inhaled 0.5mg THC doses 18 times a day, which included 4
previously
prescribed doses of 0.5 mg and many demands for additional pain relief. On the
next
day he reduced the intake to 1 mg inhalations, 4 times a day, continuing for a
period of
8 days. Throughout the treatment, and even on the first day, the patient ate 3
meals per
.. day and exhibited significant mood improvement.
Figure 9 schematically illustrates an inhaler device 2300 configured to
deliver
one or more doses comprising no more than 2 mg THC each, according to some
embodiments of the invention.
In some embodiments, the device comprises one or more cartridges 2302
comprising THC-comprising material.
In some embodiments, the device comprises a heating mechanism 2304
configured to heat the THC-comprising material to vaporize THC. In some
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embodiments, the extracted THC vapors are delivered to the user via an airflow
path
2305 and through mouthpiece 2306.
In some embodiments, the amount of material in a single cartridge 2302 is
selected so that the amount of THC extracted from the cartridge and delivered
to the
5 user comprises no more 2 mg THC, optionally between 0.2-0.5 mg THC,
between 0.3-
1.5 mg THC, between 0.5-1.5 mg THC or intermediate, larger or smaller amounts.
In some embodiments, the amount of cannabis and/or other THC-comprising
material is selected according to the extraction efficiency. In an example of
a 60%
extraction efficiency, a cartridge may include cannabis at an amount of
material
10 comprising THC at about two fold the amount of THC that is to be
delivered to the user.
For example to deliver a 2 mg THC dose to the user, a cartridge comprising
about 3.33
mg THC is heated. In some embodiments, the amount of material in each
cartridge is
selected in accordance with the THC content of the material.
In some embodiments, the amount of THC-comprising material is chosen
15 according to the potency, concentration, and/or volatility of the
vaporizing fraction.
When cannabis granulate is used, for example, the measured amount is
optionally 15
mg, or another value in the range of 10-20 mg. Choice of amount optionally
depends,
for example, on plant variety, growing conditions, and/or assay results of a
botanical
substance available for packaging. In some embodiments, the measured amount is
20 within the range, for example, of 1-20 mg, 10-40 mg, 25-75 mg, 50-100
mg, or within
another range of amounts having the same, intermediate, larger, or smaller
bounds. In
some embodiments, for example, if the required dosage is too small to fill the
substance
receiving chamber, a filler substance is optionally added; for example, a
portion of an
inert (lacking volatile drug activity) botanical substance.
25 Optionally, the filler is uniformly mixed with the required dosage."
In some embodiments, the device comprises a single cartridge with material
sufficient for a single dose of between 0.2-2 mg THC. Alternatively, the
device
comprises a plurality of cartridges, each comprising material sufficient for a
single dose.
Optionally, the number of cartridges is sufficient for use over a day.
Alternatively, the
30 number of cartridges is sufficient for use over a week. Alternatively,
the number of
cartridges is sufficient for use over a month and/or other time periods.
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Alternatively, each cartridge comprises material sufficient for more than one
dose, for example comprising material sufficient for 2 doses, 4 doses, 8 doses
or
intermediate, larger or smaller number of doses. Optionally, each cartridge
comprises
less than a single dose and the device is configured to deliver a given dose
using a
plurality of cartridges via one or more inhalation events.
In an embodiment, the device is configured to re-heat a cartridge comprising a
single dose, allowing a user to take the dose in multiple delivery events
instead of a
single delivery event, until all THC is extracted. Optionally, the device
comprises only a
single such cartridge.
In some embodiments, the device is pre-packed with THC-comprising material
having a total of no more than 4 mg THC (for example for a single delivery
event), no
more than 15 mg THC (for example for daily use), no more than 105 mg THC (for
example for weekly use) and/or intermediate, larger or smaller total amounts
of THC.
In some embodiments, a cartridge 2302 comprises one or more active substances
other than THC (for example one or more cannabinoids and/or other substances
as listed
hereinabove). Optionally, a cartridge does not comprise THC and comprises one
or
more active substances. In some embodiments, device 2300 is configured to
deliver the
one or more active substances concomitantly and/or sequentially with THC, for
example
during a single delivery event.
In some embodiments, a magazine comprising a plurality of cartridges is
provided, wherein a total amount of THC within each cartridge is no more than
4 mg,
no more than 3 mg, no more than 6 mg, no more than 1 mg, no more than 8 mg or
intermediate, larger or smaller amounts. Optionally, each of the plurality of
cartridges
contains the same amount of THC. Alternatively, some of the cartridges
comprise
different amounts of THC than others.
In some embodiments, a cartridge may include a drug combination (for example
material having a certain THC:CBD ratio). Optionally, different cartridges of
a
magazine comprise different drug combinations, and the device is configured to
select a
cartridge for use according to its content and a prescribed dosing regimen.
Structural and/or operational aspects of the inhaler device may be as
described in
one or more of the various embodiments detailed hereinabove.
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Figure 10 is a graphical representation of a regimen for the treatment of pain
by
pulmonary delivery of 0.5 mg THC doses delivered in time intervals of at least
two
hours, according to some embodiments of the invention.
In this use over a time period of 16 hours, 4 doses of 0.5 mg THC each were
provided at time intervals of at least two hours between sequential doses,
indicated by
the grey triangles. The black line represents the symptom level, in this case
pain, and the
grey line represents psychoactive effects.
The x-axis represents the time of day, and the y-axis represents an arbitrary
scale
for indicating symptom severity and level of psychoactivity. The scale
represents, based
on user reports, a grade of the symptoms and a grade of the psychoactive
effects, for
example compared to a baseline report collected from the patient before
treatment.
As can be seen in the figure, the first dose delivered at 6:30 is effective to
dramatically reduce the pain level. A rise in psychoactivity occurs. In the 4
hours that
follow the first dose, in which no additional doses or other medication are
provided, the
psychoactivity level decreases. The pain level begins to rise again at about 2
hours after
the dose was delivered.
At 12:30, another dose is inhaled, leading to a rise in psychoactivity and a
descent in the pain level. About two hours later the pain level rises again,
and another
dose is given at 18:30, reducing the pain level and causing a rise in
psychoactivity. The
last dose is delivered four hours later, at 22:30.
Optionally, before bedtime the maximal dose is increased (e.g. from 0.5 mg to
1
mg; optionally as two or more consecutive inhalations) to allow a longer
period of
reduced pain intensity.
Figure 11 is a graphical representation of the treatment effect achieved by
pulmonary delivery of 0.5 mg THC doses, delivered at time intervals of at
least two
hours, according to some embodiments of the invention.
In this example, nausea levels of a patient undergoing chemotherapy are shown,
as indicated by the arbitrary Y-axis scale. The black line depicts a typical
nausea effect
that is often witnessed when no special anti-nausea treatment is provided
(optionally
other than the conventional prophylactic treatment provided normally
intravenously in
chemotherapy sessions).
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Chemotherapy commenced at 7:00 AM, as indicated by the black arrow. As
seen, shortly after chemotherapy begins, nausea reaches a high level. It may
remain
high when not treated or even with conventional treatment, although the degree
of
nausea may fluctuate.
The gray line depicts nausea levels under treatment with 0.5 mg doses of THC,
delivered in intervals of at least two hours, indicated by the grey triangles.
The first
dose was given 30 minutes before chemotherapy started, causing a significant
delay in
the onset of nausea and a significant reduction in the maximum level reached.
Two
additional doses of 0.5 mg THC each, delivered at 12:30 and at 19:00, sufficed
to allow
the patient to combat the nausea throughout the day.
It is known that a patient may suffer from nausea even before chemotherapy
begins, for example due to anticipation of the side effect and/or because of
earlier
treatment (since nausea may last days or even weeks post a chemotherapy
treatment
session). In accordance with the above example, in some embodiments, such as
when
treating a chemotherapy patient, delivering a first dose of between 0.2-2 mg
THC before
chemotherapy begins (such as 30 minutes before, 10 minutes before, 45 minutes
before
or intermediate, longer or shorter time periods) may be advantageous.
Optionally, the
first dose is delivered as soon as the patient is diagnosed with a need for
chemotherapy,
optionally followed up with a regimen of 3-4 daily doses of 0.2-2 mg THC at
least up to
the beginning of chemotherapy, when the regimen may be adjusted.
Figure 12 is a flowchart of a method for treating a patient with a combination
of
THC and one or more other drugs, for example at least one other cannabinoid at
a
predetermined ratio, according to some embodiments of the invention.
Optionally, the method is carried out by an inhaler device that is configured
to
control the dosing regimen in accordance with the method, for example as
described
hereinabove.
In some embodiments, a combination of two or more active substances, such as
THC and at least one other cannabinoid, for example CBD are delivered. In some
cases,
it may be preferable to inhale different ratios of the active substances at
different times.
For example, when inhaling an active substance such as THC from cannabis,
there is an
entourage effect wherein many different compounds are inhaled simultaneously
and
thus yield a combined effect. In some embodiments, by selecting a specific
active
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substance combination and/or ratios, a regimen may be selected to reduce the
amount of
one or more of the active substances' intake (in any inhalation and/or in
total during a
period of time) and/or improve treatment results (e.g. by increasing a desired
effect
and/or decreasing an undesired one).
In an example, CBD, a non-psychoactive cannabinoid, known for enhancing the
therapeutic effects of THC is achieved in combination with THC. CBD has been
shown
to counteract psychotic symptoms and cognitive impairment associated with
cannabis
use as well as with THC administration. Medicinally, CBD has antipsychotic
properties
and has been shown to relieve anxiety, pain, muscle spasms, inflammation
nausea,
vomiting, convulsions and to decrease the risk for developing schizophrenia. A
potential advantage of using a combination of THC and CBD may include
achieving
extended symptom relief with reduced psycho activity. In nature, THC and CBD
are
both prevalent in cannabis and are normally inhaled simultaneously during
cannabis
usage. However, many plants already exist having different cannabinoid ratios,
and in
addition essentially any combination may be produced by mixing plants and/or
adding
or using separately extracted, purified and/or synthetic compounds.
In some embodiments, a combination of THC and at least one other cannabinoid
such as CBD and/or A9-tetrahydrocannabivarin (THCV) and/or any other
cannabinoid
that is antagonist or reverse agonist to receptor CBI extracted from plant
material or
provided as a solid/synthetic form (such as Marinol/Nabilone and CBD)
comprising a
predetermined THC:CBD ratio is delivered (2600). In some embodiments, the
amount
of THC per dose is between 0.2-2 mg. In some embodiments, the combination is
extracted from a specific strain of cannabis having a predetermined THC:CBD
ratio, for
example taking into account also the effect of growing conditions.
Additionally or
alternatively, a plurality of cannabis strains are mixed together.
Additionally or
alternatively, one or more active compounds are added to cannabis.
Additionally or
alternatively, a selection of two or more drugs are mixed together. In some
embodiments, different drug sources are used.
Optionally, an inhaler device for example as described herein comprises a
plurality of cartridges, each including a different drug. Alternatively, a
cartridge may
include mixed drugs. Optionally, a device may have a plurality of cartridges,
each
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having a different drug composition, ranging potentially from a single drug
per some
cartridge to any combination or ratio of two or more drugs in other
cartridges.
In some embodiments, the device is configured to automatically select a ratio
of
active substances delivered. Optionally, the selection is made based on input
received
5 by the device, for example based on feedback from the patient and/or based
on a
scheduled regimen received by the device. Selection of a ratio may be carried
out by
one or more of: a controller, a decision module, and/or memory components.
Examples of commercially available strains varying in their THC:CBD contents
include:
10 Bedrocan is considered a sativa type cannabis strain. Its THC-level
is
standardized at 22%, with a CBD-level below 1%.
Bedrobinol is also considered a sativa. Its THC-level can be considered
medium strength, standardized at 13.5%, with a CBD-level below 1 %.
Bediol has a lower to medium THC-level, standardized at 6.5%, and a medium
15 level of the non-psycho-active Cannabidiol (CBD), standardized at 8%.
Bediol is also a
sativa type.
Bedica is considered an indica variety. It also has medium amounts of THC,
around 14%, with less than 1% CBD.
Bedrolite is a non-psychoactive strain that contains approximately 9% CBD
20 and 0.4% THC.
In some embodiments, the following dose is delivered after at least two hours
have passed from inhalation of the first dose (2602). Optionally, at least 3
hours, at least
4 hours, at least 6 hours or intermediate, longer or shorter time periods pass
before the
next dose is provided. In some embodiments, the next dose provided comprises a
25 different THC: CBD ratio (2602). Optionally, the THC:CBD ratio of the
following dose
is larger than the THC:CBD ratio of the first dose, for example being at least
10%
larger, at least 25% larger, at least 75% larger or intermediate, higher or
lower
percentages larger. Alternatively, the THC:CBD ratio is smaller than the
THC:CBD
ratio of the first dose, for example being at least 10% smaller, at least 25%
smaller, at
30 least 75% smaller or intermediate, higher or lower percentages smaller.
In some embodiments, the ratio includes a cannabinoid that is undetectable,
for
example having a very low amount.
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In some embodiments, two or more consecutive doses are delivered 15-30
minutes of each other, until either the maximum allowed low dose of at least
one of the
active substances is reached (e.g. 0.2-2 mg THC) or until the user feels
sufficient
symptom relief and/or until reaching a maximal tolerated side effect. In some
embodiments, the following dose is delivered after at least a period of time
proportionate to the amount delivered (e.g. at least 4 hours for a total of 1
mg THC)
passed from inhalation of the consecutive doses. Optionally, at least 6 hours,
at least 8
hours, at least 10 hours or intermediate, longer or shorter time periods pass
before the
next dose is delivered.
A daily treatment regimen in which combined THC and CBD doses are
provided may include: providing morning and evening doses from a cannabis
strain
having a relatively large THC:CBD ratio, while inhalations during the day may
be
provided from cannabis stain having a smaller THC:CBD ratio. Referring to the
above
mentioned cannabis strains, it may be beneficial for the patient to inhale the
relatively
high THC Bedrocan in the morning, with two doses of Bediol during the day
and
then in the evening again Bedrocan . Thus, the patient may feel drowsy and
calm
before going to bed and also the relatively strong effect of THC in the
morning after a
long night without treatment, while during the day, more clarity and less
psychotomimetic effects may be preferred, and THC may thus be better augmented
with
a higher ratio of CBD. Optionally, when THC:CBD ratio is relatively small, a
lower
dose of THC may suffice as compared to a high ratio THC:CBD strain or drug
combination.
Figure 13 is a flowchart of a method for delivering one or more low doses of
THC, according to some embodiments of the invention.
In some embodiments, a maximal dosage is set 2700. Optionally, the maximal
dosage is set per a predetermined regimen period, for example 2 mg THC in a
two hour
interval; 3 mg in a four hour time interval; 6 mg THC in a day; 0.5 mg in an
hour and/or
other maximal dosage within any predetermined regimen period.
Once a first low dose is delivered (2702), if the maximal dosage was reached,
additional delivery is prevented for the predetermined regimen period (2710).
If the
maximal dosage was not reached, but the first delivered dose was sufficient
(for
example sufficient to alleviate one or more symptoms of the user such as pain,
nausea
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and/or other symptoms), additional delivery is prevented for the predetermined
regimen
period (2710). Alternatively, if the first delivered was not sufficient,
additional delivery
is prevented for a sensing period (2708). Optionally, the sensing period
includes a time
period sufficient for one or more effects of the inhaled THC to take place,
for example
between 5-30 minutes, between 10-50 minutes, between 1- 15 minutes, between 10-
25
minutes, or intermediate, longer or shorter time periods. Optionally, the
effects include
reducing a level of a symptom, for example as sensed and reported by the user,
by at
least 20%, at least 50%, at least 70% or intermediate, higher or lower
percentages.
Optionally, at the end of sensing period, another delivery may take place
(2702).
In some embodiments, at the end of the regimen period, additional delivery may
take place, if allowed (2712) (for example if the user did not exceed a daily
maximal
dose and/or other maximal set dose).
Figure 14 schematically describes various factors affecting a timing and/or
duration of a lock-out period 2800 set in an inhaler device, according to some
embodiments.
In some embodiments, the inhaler device is configured to lock for a time
period
throughout which additional delivery is prevented. The "lock-out" time period
may
extend for example between 1.5 hours and 12 hours, or between 2 and 6 hours,
or
between 2 and 4 hours, such as 2.5 hours, 5 hours, 7 hours, 10 hours or
intermediate,
longer or shorter time periods.
In some embodiments, the lock out time period is set according to delivery of
a
dose to the patient (2802). The "lock-out" time period may range between, for
example,
2 hours from delivery of a first dose, 3 hours from delivery of a dose (e.g. a
first dose),
7 hours from delivery of a dose, 10 hours from delivery of a dose or
intermediate,
longer or shorter time periods.
In some embodiments, the lock-out time period is set according to the active
substance composition provided and/or according to the active-substance
comprising
material used (2804). For example, the lock out period is set according to the
amount of
active substance delivered. In another example, the lock-out time period is
set according
to at least one property of the source material used, including for example
one or more
of: the type of source material used, a cannabis strain from which the THC
and/or other
active substances are extracted, the THC content of the source material, the
composition
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of active substances provided along with THC from the source material, and any
medical instruction relating for example to other active substances used by
the patient.
In another example, the lock-out time period is set according to a ratio of
cannabinoids
provided and/or according to the order in which different cannabinoids are
provided.
In some embodiments, the source material is provided in a cartridge and the
lock-out time period is set according to cartridge data (e.g. data pertaining
to the source
material) and/or prescription data (2806).
Optionally, the device controller is
configured to control timing of delivery and/or lock-out periods according to
data
automatically read from the cartridge and/or data received or sensed as input.
In some embodiments, the device is locked as a safety measure (2808).
Optionally, the device is locked to prevent or reduce the hazard of
overdosing.
Additionally or alternatively, the device is locked to prevent or reduce the
hazard of
unauthorized use, for example by a non-patient. A potential advantage of a
device
configured for locking for predetermined or selected periods of time may
include
ensuring or improving the probability of safe use for patients that are at a
higher risk for
misuse, for example children, elderly, mentally impaired patients and the
like.
In some embodiments, a timing of locking and/or a duration of a lock-out
period
are associated with general usage (2810). In some embodiments the controller
is
programmed to set heating of one or more cartridges at predetermined times,
optionally
regardless of whether inhalation took place. Optionally, a notification is
provided before
and/or during heating.
In some embodiments, the device is programmed with different time schedules
of delivery and lock-out, for example a first schedule for weekdays and a
second
schedule for weekends or holidays; a first schedule for daily use and a second
schedule
for night use, and others. Optionally, the device automatically switches
between
different schedules. Additionally or alternatively, switching is performed by
manual
control.
In some embodiments, the device is configured for automatically selecting a
cartridge for use according to a predefined lock-out period. For example, a
lock-out
period can be defined for night hours and the controller will automatically
select a
cartridge comprising a suitable source material (e.g. a certain cannabis
strain), a certain
composition of active substances etc. according to the lock out period that
was set.
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In some embodiments, in exceptional and/or emergency situations (2812), the
device is configured to allow limited delivery even during a lock-out period.
Examples
of exceptional and/or emergency situations may include: breakthrough pain or
other
increase in a treated symptom (e.g. nausea) and/or an indication that a
symptom to be
treated or prevented is sensed by the patient (e.g. an aura indicating the
onset of a
migraine), and/or occasional insufficiency of a provided amount of THC (due
for
example to some circumstance of the user or to malfunction of the device or a
defect of
the cartridge) and/or before or after a scheduled event which may require
enhanced
effect (e.g. pre-operation, chemotherapy, etc.) Optionally, exceptional
delivery is
remotely authorized, for example by a physician. In an example, a control
center and/or
a physician remotely instruct lock release. Additionally or alternatively, the
device is
programmed with predefined limitations for usage that is not according to the
regimen,
for example allowing no more than one additional maximal dose every 12 hours
or the
like.
Figure 15 is a flowchart of a delivery scheme of at least one active substance
via an inhaler device, according to some embodiments.
In some embodiments, an initial low dose is provided to the patient (2900).
Optionally, the initial dose includes THC at an amount of 0.1 mg, 0.5 mg, 0.6
mg, 0.75
mg, 1 mg, 1.5 mg, 2 mg or intermediate, larger or smaller amounts.
In some embodiments, the initial low dose is determined according to previous
treatment provided to the patient and whether the patient has previously
experienced the
effects of the provided active substance. Optionally, the initial low dose is
set based on
the patient's tolerability levels. For example, in the case of an experienced
patient, an
initial low dose of 0.5 mg is set, while for a non-experienced patient an
initial low dose
of 0.1 mg may suffice.
In some embodiments, the device receives input from the patient whether the
initial low dose was sufficient. Additionally or alternatively, the device
(i.e. the
controller) decides whether the initial low dose was sufficient, for example
by referring
to recorded usage data and/or feedback acquired from the patient).
In some embodiments, following delivery of the initial low dose, the device
allows for a first time window in which another micro dose can be provided
(2902).
Optionally, the first time window is set for up to 10 minutes following
delivery of the
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initial dose, up to 30 minutes, up to 1 hour, up to 2 hours or intermediate,
shorter or
longer time periods following delivery of the initial dose. Optionally, the
micro dose
includes an amount of active smaller than the initial dose that was provided,
for
example including 0.05 mg, 0.1 mg, 0.15 mg, 0.2 mg of THC or intermediate,
smaller
5 or larger amounts of THC.
In some embodiments, during the first time window, a maximal amount of active
substance is set and the device limits delivery of amounts larger than the
maximal set
amount. The maximal amount may be defined as the additional amount delivered
during
the first time window, or, alternatively, as the total amount delivered (i.e.
including the
10 initial dose and the additional micro dose delivered during the first
time window).
In some embodiments, a second time window is set throughout which no dose is
provided (2904). In some embodiments, during the second time window, the
device
locks and prohibits use. Alternatively, a placebo drug may be provided during
a lock-
out time period.
15 In some
embodiments, the second time window is set according to the time in
which the initial dose was delivered, for example preventing delivery for at
least two
hours, at least 5 hours, at least 10 hours or intermediate, longer or shorter
time periods
from the delivery of the initial dose. Alternatively, the second time window
is set
according to a time in which the dose was augmented by delivery of the micro
dose.
20 In some
embodiments, during the first time window, the patient is allowed to
take a plurality of doses (up to a maximal amount allowed amount) until a
symptom is
sufficiently alleviated. Optionally, a duration of the second time window is
longer than
the first time window, yet is short enough to prevent the patient from
returning to their
pre-treatment condition.
25 In some
embodiments, the device controller determines whether or not to enable
delivery by referring to previous deliveries made within the last hours or
days, for
example previous deliveries made in the last two hours, the last 5 hours, the
last 10
hours or intermediate, longer or shorter time periods. Optionally, the
decision is made
upon an attempt of the patient to inhale and/or by the patient turning the
device on
30 and/or
any other patient instruction received by the device, indicating that the
patient is
interested in taking another dose. In some embodiments, the controller sets an
amount to
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be delivered by taking into account previous amounts provided within a defined
time
period from a time point in which the patient attempts use.
Figure 16 is a graph of a delivery scheme of at least one active substance via
an
inhaler device, according to some embodiments.
In some embodiments, a maximal amount of active substance is allocated for a
predefined time period. In the example shown herein, a total of 0.5 mg is
allocated for a
2 hour time period.
In some embodiments, delivery is limited according to a budgetary profile.
Optionally, the device is configured to limit an amount delivered at each use
session
performed within the predefined time period so as to "save some for later". A
cumulative scheme is presented in this example: an initial low dose 3000 of
0.3 mg is
provided, followed by a plurality of micro doses summing up to a total of 0.5
mg
delivered within a time period of 2 hours. The micro doses may include, for
example,
descending amounts which together with the initial low dose converge towards
the
maximal amount (e.g. 0.5 mg). For example, micro dose 3002 includes 0.1 mg;
micro
dose 3004 includes 0.05 mg; micro dose 3006 includes 0.02 mg and so forth.
Optionally, doses provided towards the end of the time period include
extremely small
amounts, e.g. 0.01 mg.
An alternative delivery profile may include a "free manner" delivery in which
any amount can be taken within the predefined time period, as long as the
total amount
delivered does not exceed the maximal amount. Optionally, the patient sets the
specific
amounts provided within the predefined time period, and the device limits use
when the
patient surpasses the maximal amount.
The dimensions and values disclosed herein are not to be understood as being
strictly limited to the exact numerical values recited. Instead, unless
otherwise
specified, each such dimension is intended to mean both the recited value and
a
functionally equivalent range surrounding that value. For example, a dimension
disclosed as "10 p.m" is intended to mean "about 10 p.m".
As used herein, numerical ranges preceded by the term "about" should not be
considered to be limited to the recited range. Rather, numerical ranges
preceded by the
term "about" should be understood to include a range accepted by those skilled
in the
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art for any given element in microcapsules or formulations according to the
present
disclosure.
The term "such as" should be taken to mean "for example" without any further
limitation.
The term "about" as used herein means within an acceptable error range for a
particular value as determined by one of ordinary skill in the art, which will
depend in
part on how the value is measured or determined, i.e., the limitations of the
measurement system. For example, "about" can mean a range of up to 10 %, more
preferably up to 5%, and still more preferably up to 1% of a given value.
Where
particular values are described in the application and claims, unless
otherwise stated, the
meaning of the term "about" is within an acceptable error range for the
particular value.
The terms "comprises", "comprising", "includes", "including", "having" and
their conjugates mean "including but not limited to".
The term "consisting of' means "including and limited to".
The term "consisting essentially of" means that the composition, method or
microcapsules may include additional ingredients, steps and/or parts, but only
if the
additional ingredients, steps and/or parts do not materially alter the basic
and novel
characteristics of the claimed composition, method or structure.
As used herein, the singular form "a", "an" and "the" include plural
references
unless the context clearly dictates otherwise. For example, the term "a
compound" or
"at least one compound" may include a plurality of compounds, including
mixtures
thereof.
As used herein the term "method" refers to manners, means, techniques and
procedures for accomplishing a given task including, but not limited to, those
manners,
means, techniques and procedures either known to, or readily developed from
known
manners, means, techniques and procedures by practitioners of the chemical,
pharmacological, biological, biochemical and medical arts.
It is appreciated that certain features of the invention, which are, for
clarity,
described in the context of separate embodiments, may also be provided in
combination
in a single embodiment. Conversely, various features of the invention, which
are, for
brevity, described in the context of a single embodiment, may also be provided
separately or in any suitable subcombination or as suitable in any other
described
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embodiment of the invention. Certain features described in the context of
various
embodiments are not to be considered essential features of those embodiments,
unless
the embodiment is inoperative without those elements.
Various embodiments and aspects of the present disclosure as delineated
hereinabove and as claimed in the claims section below find experimental
support in the
following examples.
Although the invention has been described in conjunction with specific
embodiments thereof, it is evident that many alternatives, modifications and
variations
will be apparent to those skilled in the art. Accordingly, it is intended to
embrace all
such alternatives, modifications and variations that fall within the spirit
and broad scope
of the appended claims.
All publications, patents and patent applications mentioned in this
specification
are herein incorporated in their entirety by reference into the specification,
to the same
extent as if each individual publication, patent or patent application was
specifically and
individually indicated to be incorporated herein by reference. In addition,
citation or
identification of any reference in this application shall not be construed as
an admission
that such reference is available as prior art to the present disclosure. To
the extent that
section headings are used, they should not be construed as necessarily
limiting.
